Mid-term results
The survival rate was 94.8% at a mean follow-up time of 26.4 months in
our study. In comparison to Ozaki’s study, the survival rate of 850
patients was 85.9%,11 at a mean follow-up time of
53.5 months, and it was 98.1% at a mean follow-up time of 14 months
after surgery according to Krane et al.17 In our
study, 02 patients died from ascending aortic pseudoaneurysm rupture at
3 and 8 months after surgery, respectively. These patients were admitted
to the hospital with a diagnosis of postoperative sternitis and both
underwent an operation for stainless steel suture removal and
debridement. However, the infection progressed to spread into the
mediastinum and caused a pseudoaneurysm at the aorta incision site and
then rupture. During Ozaki’s procedure, the extensive dissection and
harvest of the anterior pericardium could be a risk factor infection
from the sternum to spread into the anterior mediastinum.
The cumulative incidence of reoperation was 2.8%, including 02 patients
who required reoperation for endocarditis. As reported by Ozaki in 850
patients, there were 13 patients reoperated due to
endocarditis.11 The incidence of reoperation due to
degeneration and calcification was extremely low. In our study, no
patient had valvular degeneration during follow-up despite the
relatively low mean age (52.9). The procedure of harvesting the
pericardium, treatment with glutaraldehyde, and rinsing all required
absolute sterility.
The cumulative incidence of aortic regurgitation was 4.2%, including 01
patient who had moderate regurgitation immediately after surgery without
progression at 42 months follow up and 02 patients who had severe
regurgitation due to endocarditis that underwent reoperation after 03
and 06 months, respectively. In comparison, the incidences of moderate
or higher aortic regurgitation reported by Ozaki and Krane were 7.3%
(the follow-up of 53.6 months) and 3% (the follow-up of 14 months),
respectively.11,17 In Ozaki’s procedure, the height of
the cusps are elevated to the level of the sinotubular junction in the
aorta which increases the aortic cusp coaptation than that with the
natural valve, thus limiting the risk of cusp prolapse and subsequent
aortic regurgitation.
Aortic valve hemodynamics were favorable, with a post-operative peak
gradient pressure of 16.1 to 17.1 mmHg. All patients have been
prescribed aspirin 100 mg only if in sinus rhythm after surgery and no
bleeding or thromboembolic complications were observed.
In conclusion, aortic valve reconstruction surgery by Ozaki procedure
was a safe approach, with a low mortality rate and a high technical
success rate. This technique could be implemented in various types of
aortic valve diseases and morphology. Hemodynamics of reconstructed
valves were favorable with a low cumulative incidence of aortic
regurgitation without prosthesis-patient mismatch. However, this
technique is limited by a longer aortic cross-clamp time,
cardiopulmonary bypass time than in prosthetic valve replacement. The
longest follow-up time was 42 months; therefore, it is necessary to
continue the follow-up to evaluate long-term outcomes.