Short-term outcomes of aortic valve neocuspidization using autologous fixed pericardium versus aortic valve replacement using mechanical prosthesis in patients with aortic valve disease

Abstract

Background Aortic valve replacement by prosthetic valves, either mechanical or biological, is the ultimate known therapy for patients with aortic valve disease whether stenosis or regurgitation. However, these prostheses may have the concern of valve degeneration and the need for reoperation with the biological valves or the need for lifelong anticoagulation with considerable side effects with the mechanical valves. In this study, we compare the application of the new Ozaki technique in Ain Shams University Hospitals Cardiothoracic Academy to the current practice of aortic valve replacement using mechanical valve prosthesis Aim of the work To study the hemodynamic performance and major adverse events that are related to the valve of the novel technique in reconstructing the aortic valve using autologous pericardium (AVNeo) versus the conventional aortic valve replacement using a prosthetic mechanical valve. Patients and methods This was a nonrandomized clinical trial on 20 patients conducted at Ain Shams University Hospitals Cardiothoracic Academy during the period from November 2021 to December 2022. Inclusion criteria include age from 18 to 65 years, moderate to severe aortic stenosis, and sole aortic valve disease. Exclusion criteria include refusal of the Ozaki technique, concomitant intervention of the aortic arch, emergency surgery, porcelain aorta, and previous cardiac surgery. We divided the patient population into two groups through nonrandom allocation: Group I: aortic valve neocuspidization using autologous fixed pericardium and group II: aortic valve replacement using mechanical prosthesis. Results The hemodynamic performance of patients who underwent aortic valve replacement with either the AVNeo or AVR techniques was evaluated at discharge and 3 months postsurgery. No significant differences were observed in mean and median values of MPG, vena contracta, and coaptation length between the groups at discharge and 3 months postsurgery. However, at 3 months, the mean PPG was significantly lower in the AVNeo group compared with the AVR group (14.80±3.01 vs. 24.00±6.80, P<0.001). In addition, there was a significant decrease in mean PPG and MPG values within the AVNeo group at 3 months compared with at discharge (P=0.005 and P<0.001, respectively), whereas no significant change was observed in the AVR group. These findings suggest that the AVNeo technique may offer better hemodynamic outcomes in terms of PPG compared with the AVR technique at 3 months postsurgery. Conclusion Results showed that both AVNeo and AVR exhibit comparable outcomes at discharge and at 3 months after the study’s conclusion. The postoperative morbidity and mortality are low with the Ozaki procedure, making it dependable and safe.