Understanding aortic valve repair through Ozaki procedure: A review of literature evidence

Abstract

Background Aortic valve neocuspidization (AV Neo) using glutaraldehyde‐treated autologous pericardium was first reported by Ozaki et al. in 2007. This technique has become an alternative to tissue and mechanical valve in selected patients as long‐term anticoagulation is not required and shows promising midterm results and durability. Method A comprehensive search was performed on the major database using the search terms “Ozaki technique” AND “Aortic Valve Neocuspidization” AND “AV Neocuspidization” AND “Autologous pericardium” AND “glutaraldehyde‐treated autologous pericardium.” Articles up to August 1st, 2021 were included in this study. Results A total of nine studies with a total of 1342 patients were included. The mean age was 67.36 and 54.23% were male. 66.32% and 23.92% of patients had aortic stenosis and aortic regurgitation, respectively. 66% of patients had a native tricuspid aortic valve (AV) and 31.37% of patients' native AV was bicuspid. Three studies reported their experience performing AV Neo via ministernotomy. Conclusion AV Neo can be a suitable alternative to surgical AV replacement in selected patients. The short‐ and midterm outcomes are comparable without the need for long‐term oral anticoagulation. Long‐term follow‐up data are required for this novel approach to be widely adopted.

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

“…The average living age of the population is constantly increasing and so is the incidence and prevalence of aortic valve disease, mainly being aortic stenosis or regurgitation. 1 Aortic stenosis (AS), often caused by calcification of the valve, is the commonest form of aortic valve disease and has an incidence of 0.2% during the fifth decade of life and 1.3% during the sixth, 3.9% in those aged 70-79 and 9.8% in 80-89, according to a 2013 population-based prospective study. 2 Other studies argue that the incidence of AS at age 65 is actually | 5207 higher at 5%.…”

“…We read with great interest the recent review article by Chan et al 1 highlighting the surgical approach, clinical outcomes, and limitations of the Ozaki procedure. The review benefits from a robust and clearly defined methodology which has translated to a well‐written and thorough research piece.…”

“…The authors showcased the results of the Ozaki procedure in 1342 patients from nine eligible studies, showing favourable clinical outcomes including good mortality and low incidence of postoperative complications such as stroke and infective endocarditis (IE) as well as a comparable need for secondary reintervention. Nevertheless, the authors described several limitations of this procedure that might hinder results such as prolonged operative times and a steep learning curve 1 …”

“…The pericardium is harvested and treated with glutaraldehyde then shaped to form cusps measured precisely using sizing and templating tools developed by Professor Ozaki from Japan, hence where it gets its name from. The absence of foreign valve material means no long‐term oral anticoagulation is required 1,6 . Although this technique, despite its novelty and significant learning curve, has been able to achieve favourable results in select patient populations, a superior approach to AV Neo exists.…”

“…As described by the father of this procedure Dr. Batista, this technique is simple, inexpensive, applicable to all cases of aortic valve disease, and importantly, does not necessitate anticoagulation as the amount of foreign material is minimal. Moreover, when used to treat congenital heart disease in children, it may allow for annular growth 1,7 …”