Aortic valve neocuspidization using autologous versus bovine pericardium: Ozaki versus Batista

Abstract

Background The average living age of the population is constantly increasing and so is the incidence and prevalence of aortic valve disease. Surgical aortic valve replacement (SAVR) is the current gold standard treatment. Nevertheless, the use of prosthetic valves in SAVR is associated with issues that impact patients' quality of life. Aortic valve neocuspidization (AV Neo) offers a means to solve this dilemma by minimizing foreign valve tissue. AV Neo can either be performed using glutaraldehyde‐treated autologous pericardium (Ozaki procedure) or bovine pericardium (Batista procedure). Aims This commentary aims to discuss the recent study by Chan and colleagues which highlighted the surgical approach, clinical outcomes, and limitations of the Ozaki procedure, and compare this to the Batista procedure. Methods A comprehensive literature search was performed using multiple electronic databases including PubMed, Ovid, Embase, and Scopus to collate the relevant research evidence. Results Although the Ozaki procedure can achieve favorable results whilst mainly avoiding the need for life‐long oral anticoagulation with mechanical valves, it still has several limitations that may hinder results. AV Neo using glutaraldehyde‐treated bovine pericardium, developed by pioneer cardiac surgeon Dr. Randas J. Vilela Batista, yields superior clinical outcomes to Ozaki's, including excellent survival, lower complications, and minimal need for reoperation as well as shorter operative times. Conclusion AV Neo offers a means to perform SAVR whilst escaping the prosthetic valve issues. However, the Batista procedure has shown beyond doubt that it can be considered the superior approach for AV Neo over the Ozaki procedure.

Tissue requirements for the application of aortic valve neocuspidization – appropriate pericardium properties and homogeneity?

“…In contrast to quality assured bovine pericardium in industrial fabrication, human tissues are not pre-evaluated prior to cusp excision in the theater. This can be achieved by using bovine pericardial patch material instead of autologous tissue on the one hand applying the Ozaki-protocol but also by preparation of a mono-patch pre-cut according to the Batista et al established already in the eighties [ 22 – 25 ]. Clinical outcomes using bovine pericardium without stent in the Ozaki-like procedure have recently been turned out to even result in inferior results and decreased operation times (cardiopulmonary bypass time 143.8 min in AVNeo and 90.3 min in surgery using bovine pericardium) due to the possibility to prepare the patch before the surgical procedure starts [ 24 , 25 ].…”

“…This can be achieved by using bovine pericardial patch material instead of autologous tissue on the one hand applying the Ozaki-protocol but also by preparation of a mono-patch pre-cut according to the Batista et al established already in the eighties [ 22 – 25 ]. Clinical outcomes using bovine pericardium without stent in the Ozaki-like procedure have recently been turned out to even result in inferior results and decreased operation times (cardiopulmonary bypass time 143.8 min in AVNeo and 90.3 min in surgery using bovine pericardium) due to the possibility to prepare the patch before the surgical procedure starts [ 24 , 25 ]. Mortality after AVNeo using human pericardium was with 2.7% higher and survival rate of 85.9% lower than in surgery using bovine pericardium patch (1.2% mortality and 94.7% survival rate) [ 25 ].…”

“…Clinical outcomes using bovine pericardium without stent in the Ozaki-like procedure have recently been turned out to even result in inferior results and decreased operation times (cardiopulmonary bypass time 143.8 min in AVNeo and 90.3 min in surgery using bovine pericardium) due to the possibility to prepare the patch before the surgical procedure starts [ 24 , 25 ]. Mortality after AVNeo using human pericardium was with 2.7% higher and survival rate of 85.9% lower than in surgery using bovine pericardium patch (1.2% mortality and 94.7% survival rate) [ 25 ]. Nevertheless immunological disadvantages by using xenogeneic material can essentially impact the longevity of aortic valve replacement tissue and have even more effect than tissue properties.…”