Results
Between June 2017 and December 2019, a total of 72 patients with isolated aortic valve disease underwent aortic valve reconstruction surgery using Ozaki’s procedure at our hospital. We obtained the following results after a mean follow-up time of 26.4 months (range 12-42 months).
Table 1 depicts preoperative characteristics of the study cohort. The mean age was 52.9 (19 – 79 years old), male/female ratio was 3/1, and the most common clinical symptoms were dyspnea (95.8%), angina (62.5%). In addition, the bicuspid aortic valve accounted for 28%.
Table 2 represents intraoperative parameters. The proportion of patients with small aortic annulus (≤ 21mm) was 38.9%. The number of patients with one, two, or three reconstructed cusps was 03, 07, and 62, respectively. The mean aortic cross-clamp time was 106.3 minutes, and the bicuspid-morphology group needed shorter time than the tricuspid-morphology group (94.7 minutes versus 109.7 minutes, p = 0.03). Two patients required conversion to prosthetic valve replacement due to occlusion of left coronary arterial ostium caused by a reconstructed cusp.
Thirty-day postoperative results are shown in Table 3. There was one in-hospital death due to acute cardiac tamponade caused by bleeding in postoperative day 1, and two patients required reoperation due to postoperative bleeding and infection of the sternum.
The mid-term results showed a survival rate of 95.8% at a mean follow-up time of 26.4 months (Figure 1A). A total of three patients died during following, including one patient had acute cardiac tamponade on post-operative day 1 and two patients had rupture of pseudoaneurysm at 3 and 8 months after surgery. The cumulative incidence of reoperation related to the reconstructed aortic valve was 2.8% (02 patients had reoperation due to endocarditis at 6 and 24 months after surgery) (Figure 1B). The cumulative incidence of moderate or higher aortic regurgitation was 4.2% (one patient had moderate regurgitation immediately after surgery, and 02 patients had severe regurgitation due to endocarditis that required reoperation) (Figure 1C). The peak pressure gradient was stable during follow-up (16.1 to 17.1 mmHg), and the effective orifice area index was 2.3-2.5 cm2 (Figure 2).