Feasibility and Outcome of Cardiovascular Surgeries Combined with Ozaki Procedure; Single Center Single Surgeon Experience

Abstract

Objective: Considering aortic valve surgeries, use of prosthetic valves is associated with issues of quality, technology, availability and affordability in developing countries like Sri Lanka. In such setting, Ozaki procedure can be used to treat spectrum of aortic valve diseases, and can be combined with other cardiac surgeries. This study focused on recapitulating the current practice of Ozaki procedure combined with other cardiac surgeries. Methods: This retrospective cross sectional study was carried out from October 2019 to October 2020 at National Hospital Kandy. All patients were operated by a single surgeon. Total number of patients were 10 (6 males, 4 females) with mean age 52 years. Severe aortic stenosis 6, severe aortic regurgitation 3, combination of both 1, were assigned for Ozaki procedure and combined as follows. One patient had undergone isolated Ozaki procedure following aortic valve vegetectomy. Results: All patients were successfully weaned from CPB. Intra-operative echocardiogram showed no significant aortic or mitral regurgitation. Ejection fraction was preserved at 50 ±10%. Mean cross-clamp time for AV reconstruction only was 92 ± 18 minutes and mean length of stay on the intensive care unit was 70 ± 18 hours and hospital stay was 6 ± 1.5 days after combined procedures. No pacemaker implanted after all procedure. No reoperation done. Conclusions: In our experience, this technique can be mastered after a relatively short training period, can be used for variety of aortic valvular pathology, can combined successfully with other surgeries and even with aortic conduits. Ozaki procedure remains a very attractive strategy with excellent haemodynamics and may have the potential to overcome the structural disadvantages of prosthetic valves including use of warfarin. Combined procedure No of cases Coronary artery bypass grafting 5 Mitral valve ring annuloplasty 1 Coronary artery bypass grafting/ Mitral valve ring annuloplasty 1 Ascending aortic replacement 2