Aortic Valve Reconstruction With Autologous Pericardium Versus a Bioprosthesis: The Ozaki Procedure in Perspective
Background We assessed the Ozaki procedure, aortic valve reconstruction using autologous pericardium, with respect to its learning curve, hemodynamic performance, and durability compared with a stented bioprosthesis. Methods and Results From January 2007 to January 2016, 776 patients underwent an Oz...
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.027391 |
| _version_ | 1811170036773027840 |
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| author | Shinya Unai Shigeyuki Ozaki Douglas R. Johnston Tomohiro Saito Jeevanantham Rajeswaran Lars G. Svensson Eugene H. Blackstone Gösta B. Pettersson |
| author_facet | Shinya Unai Shigeyuki Ozaki Douglas R. Johnston Tomohiro Saito Jeevanantham Rajeswaran Lars G. Svensson Eugene H. Blackstone Gösta B. Pettersson |
| author_sort | Shinya Unai |
| collection | DOAJ |
| description | Background We assessed the Ozaki procedure, aortic valve reconstruction using autologous pericardium, with respect to its learning curve, hemodynamic performance, and durability compared with a stented bioprosthesis. Methods and Results From January 2007 to January 2016, 776 patients underwent an Ozaki procedure at Toho University Ohashi Medical Center. Learning curves, aortic regurgitation (AR), and peak gradient, assessed by serial echocardiograms, valve rereplacement, and survival were investigated. Valve performance and durability were compared with 627 1:1 propensity‐matched patients receiving stented bovine pericardial valves implanted from 1982 to 2011 at Cleveland Clinic. Learning curves were observed for aortic clamp and cardiopulmonary bypass times, AR prevalence, and early mortality. Decreased aortic clamp time was observed over the first 300 cases. New surgeons performing parts of the procedure after case 400 resulted in a slight increase in aortic clamp and cardiopulmonary bypass times. Among matched patients, the Ozaki cohort had more AR than the PERIMOUNT cohort (severe AR at 1 and 6 years, 0.58% and 3.6% versus 0.45% and 1.0%, respectively; P[trend]=0.006), although with a steep learning curve. Peak gradient showed the opposite trend: 14 and 17 mm Hg for Ozaki and 24 and 28 mm Hg for PERIMOUNT at these times (P[trend]<0.001). Freedom from rereplacement was similar (P=0.491). Survival of the Ozaki cohort was 85% at 6 years. Conclusions Patients undergoing the Ozaki procedure had lower gradients but more recurrent AR than those receiving PERIMOUNT bioprostheses. Although recurrent AR is concerning, results confirm low risk and good midterm performance of the Ozaki procedure, supporting its continued use. |
| first_indexed | 2024-04-10T16:52:01Z |
| format | Article |
| id | doaj.art-6ace1722cd1f4dd7a4b983347b6eb424 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T16:52:01Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-6ace1722cd1f4dd7a4b983347b6eb4242023-02-07T16:01:10ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-01-0112210.1161/JAHA.122.027391Aortic Valve Reconstruction With Autologous Pericardium Versus a Bioprosthesis: The Ozaki Procedure in PerspectiveShinya Unai0Shigeyuki Ozaki1Douglas R. Johnston2Tomohiro Saito3Jeevanantham Rajeswaran4Lars G. Svensson5Eugene H. Blackstone6Gösta B. Pettersson7Department of Thoracic and Cardiovascular Surgery Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OHDepartment of Cardiovascular Surgery Toho University Ohashi Medical Center Tokyo JapanDepartment of Thoracic and Cardiovascular Surgery Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OHDepartment of Cardiovascular Surgery Toho University Ohashi Medical Center Tokyo JapanDepartment of Quantitative Health Sciences Lerner Research Institute Cleveland Clinic Cleveland OHDepartment of Thoracic and Cardiovascular Surgery Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OHDepartment of Thoracic and Cardiovascular Surgery Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OHDepartment of Thoracic and Cardiovascular Surgery Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OHBackground We assessed the Ozaki procedure, aortic valve reconstruction using autologous pericardium, with respect to its learning curve, hemodynamic performance, and durability compared with a stented bioprosthesis. Methods and Results From January 2007 to January 2016, 776 patients underwent an Ozaki procedure at Toho University Ohashi Medical Center. Learning curves, aortic regurgitation (AR), and peak gradient, assessed by serial echocardiograms, valve rereplacement, and survival were investigated. Valve performance and durability were compared with 627 1:1 propensity‐matched patients receiving stented bovine pericardial valves implanted from 1982 to 2011 at Cleveland Clinic. Learning curves were observed for aortic clamp and cardiopulmonary bypass times, AR prevalence, and early mortality. Decreased aortic clamp time was observed over the first 300 cases. New surgeons performing parts of the procedure after case 400 resulted in a slight increase in aortic clamp and cardiopulmonary bypass times. Among matched patients, the Ozaki cohort had more AR than the PERIMOUNT cohort (severe AR at 1 and 6 years, 0.58% and 3.6% versus 0.45% and 1.0%, respectively; P[trend]=0.006), although with a steep learning curve. Peak gradient showed the opposite trend: 14 and 17 mm Hg for Ozaki and 24 and 28 mm Hg for PERIMOUNT at these times (P[trend]<0.001). Freedom from rereplacement was similar (P=0.491). Survival of the Ozaki cohort was 85% at 6 years. Conclusions Patients undergoing the Ozaki procedure had lower gradients but more recurrent AR than those receiving PERIMOUNT bioprostheses. Although recurrent AR is concerning, results confirm low risk and good midterm performance of the Ozaki procedure, supporting its continued use.https://www.ahajournals.org/doi/10.1161/JAHA.122.027391aortic valve reconstructionaortic valve replacementautologous pericardiumOzaki procedure |
| spellingShingle | Shinya Unai Shigeyuki Ozaki Douglas R. Johnston Tomohiro Saito Jeevanantham Rajeswaran Lars G. Svensson Eugene H. Blackstone Gösta B. Pettersson Aortic Valve Reconstruction With Autologous Pericardium Versus a Bioprosthesis: The Ozaki Procedure in Perspective Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic valve reconstruction aortic valve replacement autologous pericardium Ozaki procedure |
| title | Aortic Valve Reconstruction With Autologous Pericardium Versus a Bioprosthesis: The Ozaki Procedure in Perspective |
| title_full | Aortic Valve Reconstruction With Autologous Pericardium Versus a Bioprosthesis: The Ozaki Procedure in Perspective |
| title_fullStr | Aortic Valve Reconstruction With Autologous Pericardium Versus a Bioprosthesis: The Ozaki Procedure in Perspective |
| title_full_unstemmed | Aortic Valve Reconstruction With Autologous Pericardium Versus a Bioprosthesis: The Ozaki Procedure in Perspective |
| title_short | Aortic Valve Reconstruction With Autologous Pericardium Versus a Bioprosthesis: The Ozaki Procedure in Perspective |
| title_sort | aortic valve reconstruction with autologous pericardium versus a bioprosthesis the ozaki procedure in perspective |
| topic | aortic valve reconstruction aortic valve replacement autologous pericardium Ozaki procedure |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.027391 |
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