Aortic Valve Neocuspidization with Glutaraldehyde-Treated Autologous Pericardium (Ozaki Procedure) – A Promising Surgical Technique

Abstract

In cases of aortic valve disease, prosthetic valves have been increasingly used for valve replacement, however, there are inherent problems with prostheses, and their quality in the so-called Third World countries is lower in comparison to new-generation models, which leads to shorter durability. Recently, transcatheter aortic valve replacement has been explored as a less invasive option for patients with high-risk surgical profile.In this scenario, aortic valve neocuspidization (AVNeo) has emerged as another option, which can be applied to a wide spectrum of aortic valve diseases. Despite the promising results, this procedure is not widely spread among cardiac surgeons yet. Spurred on by the last publications, we went on to write an overview of the current practice of state-of-the-art AVNeo and its results.

Aortic Valve Neocuspidization Using Autologous Pericardium (Ozaki Procedure): an Alternative to Aortic Valve Replacement in Adult Cardiac Surgery?

“…In patients with isolated aortic stenosis, Iida and colleagues report a mean peak pressure gradient of 22 ± 10.7 mmHg one week after the procedure and 19.2 ± 9.7 mmHg after 20 months [8]. In our cohort, after median 21 months of followup, median (IQR) mean and peak gradients were 6 (5,9) mmHg and 12 (8, 17) mmHg, respectively; these results are similar to recently published data from a US center [12].…”

“…Moderate aortic regurgitation was seen in two patients (7%). Median (IQR) mean gradient was 6 (5,9) mmHg, and median (IQR) peak gradient was 12 (8,17) mmHg [14•].…”

“…Notwithstanding, the aortic valve replacement (AVR) technique with autologous glutaraldehyde-treated pericardium to rebuild the aortic valve, the so called "OZAKI" procedure (also referred to as "aortic valve neocuspidization, AVNeo"), has gained popularity within the past years [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The concept of using (autologous) pericardium to reconstruct/rebuild the aortic valve is well known in pediatric cardiac surgery.…”

The Gordian Knot of Glutaraldehyde-Treated Autologous Pericardium in Open Cardiac Surgery

“…In cardiac surgery, for example the technique inclusive of Ozaky procedure, the aortic valve repair using neocuspidalization, require intraoperative taken fresh autologous pericardium patch before implant. Usually, the pericardium is immersed in aqueous solution with GA concentration up to 600 ppm, and then it is washed [13,14]. After that, the treated pericardium is anchored to the patient's aortic tissues as a function of the new apparatus valvular.…”

Aortic valve neocuspidization in the lifetime management of aortic valve disease

“…1 We agree with our colleagues on the issue of aortic valve neocuspidization (AVNeo-Ozaki procedure-Figure 1) with autologous pericardium as an additional surgical option to be included in the surgical toolbox. 2 Besides Japan (where the technique was developed), this surgical procedure has been gaining ground all over the world.…”