Midterm outcomes of the Ozaki procedure in patients with a bicuspid aortic valve: retrospective single-center, non-randomized, parallel-group study

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Abstract

BACKGROUND: An alternative to plastic surgery on the bicuspid aortic valve (BAV) can be replacement of the leaflets with autopericardium using the Ozaki technique. The procedure is characterized by excellent hemodynamic results in the short and long term in patients with tricuspid aortic valve (TAV). However, the question remains about the long-term results of the procedure and the frequency of reoperations in patients with BAV.

OBJECTIVE: To analyze the midterm outcomes of the Ozaki procedure in patients with BAV.

MATERIALS AND METHODS: Retrospective single-center, non-randomized, parallel-group study was conducted. Since January 2015 to October 1, 2023, the clinic performed 809 Ozaki procedures. The work included 540 patients with studied midterm and long-term outcomes for up to 5 years. Both isolated aortic valve replacement and combined operations with coronary artery bypass grafting and (or) correction of mitral and tricuspid valve defects were performed.

RESULTS: Midterm mortality was 5.7% (n=3) in the group with BAV and 7.3% (n=36) in the group with TAV. Reoperation for aortic regurgitation was required in 16 patients (2.9%): 1 patient (1.9%) in BAV group and 15 (3.3%) in TAV group. Freedom from reoperations in patients with BAV after the Ozaki procedure for up to 5 years was 95.4%, in the group with TAV — 92.6%. The peak gradient on the aortic valve in the group with BAV was 16±7.3, in TAV group — 16.4±10.9. 5 years after surgery, the mean gradient on the aortic valve does not exceed 10 mm Hg.

CONCLUSION: The Ozaki operation in patients with BAV is an effective and safe procedure in the midterm follow-up period.

About the authors

Vladlen V. Bazylev

Federal Center of Cardiovascular Surgery

Email: cardio-penza@yandex.ru
ORCID iD: 0000-0001-6089-9722
SPIN-code: 3153-8026

MD, Dr. Sci. (Med.), Professor, cardiovascular surgeon, chief physician

Russian Federation, Penza

Andrey B. Voevodin

Federal Center of Cardiovascular Surgery

Email: voevodin.ab@gmail.com
ORCID iD: 0000-0002-7078-1274
SPIN-code: 7869-9962

MD, Cand. Sci. (Med.), cardiovascular surgeon, department head

Russian Federation, Penza

Vadim A. Karnakhin

Federal Center of Cardiovascular Surgery

Email: vkhin@mail.ru
ORCID iD: 0000-0002-1815-7116
SPIN-code: 5680-7893

MD, Cand. Sci. (Med.), cardiovascular surgeon

Russian Federation, Penza

Ivan D. Potopalskiy

Federal Center of Cardiovascular Surgery

Author for correspondence.
Email: potopalskiy.i@gmail.com
ORCID iD: 0000-0001-6412-7893
SPIN-code: 8457-4672

cardiovascular surgeon

Russian Federation, Penza

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2. Fig. 1. Cumulative mortality function after the Ozaki procedure by group(82,6±4,1% — ДАК, 78,4±1,3% — ТАК, Cox-Mantel — 0,1).). Note (here and Fig. 2–4). ДАК — bicuspid aortic valve, ТАК — tricuspid aortic valve.

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3. Fig. 2. Cumulative distribution function of freedom from reoperation after the Ozaki procedure by group (95,4±1,3% — ДАК, 92,6±0,9% — ТАК, Cox-Mantel — 0,6).

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4. Fig. 3. Peak pressure gradient across the aortic valve after the Ozaki procedure by group before surgery and in the mid-term period.

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5. Fig. 4. Middle pressure gradient across the aortic valve after the Ozaki procedure by group before surgery and in the mid-term period.

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