Ozaki Procedure Research Articles

An Ex Vivo Porcine Model for Hydrodynamic Testing of Experimental Aortic Valve Procedures and Novel Medical Devices.

The options for testing new cardiac procedures and investigative medical devices prior to use in an animal model are limited. In this study, we present a method for mounting a porcine aortic valve in a pulse duplicator to evaluate its hydrodynamic properties. These properties can then be evaluated before and after the procedure under investigation is performed and/or the investigative medical device is applied. Securing the inflow segment presents some difficulty owing to the lack of circumferential myocardium in the left ventricular outflow tract. This method addresses that issue by securing the inflow segment using the anterior leaflet of the mitral valve and then suturing the left ventricular free wall around the inflow fixture. The outflow segment is secured simply by inserting the fixture into an incision in the superior aspect of the aortic arch. We found that specimens had significantly different hydrodynamic properties before and after tissue fixation. This finding induced us to use fresh specimens in our testing and should be considered when using this method. In our work, we used this method to test novel intracardiac patch materials for use in the valvular position by performing an aortic valve neocuspidization procedure (Ozaki procedure) on the mounted porcine aortic valves. These valves were tested before and after the procedure to assess the change in hydrodynamic properties in comparison to the native valve. Herein, we report a platform for hydrodynamic testing of experimental aortic valve procedures that enables comparison with the native valve and between different devices and techniques used for the procedure under investigation.

The Role of Echocardiography and Cardiac Computed Tomography in Diagnosis of Infective Endocarditis.

Infective endocarditis (IE) is a rare disease with a high mortality rate and rising incidence, requiring timely and precise diagnosis in order to choose appropriate therapy. Imaging of morphologic lesions is an integrative part of diagnosis. Artifacts and the patient's habitus make echocardiography difficult to visualize advanced-form IE. Cardiac computed tomography (CCT) constantly shows an additive diagnostic value due to high resolution of cardiac anatomy. Conjecturally, joint application of both diagnostic tests improves overall sensitivity and specificity in diagnosing IE. Patients with definite IE underwent transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and CCT. We analyzed valvular and paravalvular IE lesions in all three imaging methods and compared them to surgical or autopsy findings. We calculated sensitivity, specificity, diagnostic accuracy, and positive and negative predictive value of both imaging tests individually and jointly used. We examined 78 patients, male to female ratio 2:1, mean age 52.29 ± 16.62. We analyzed 85 valves, 70 native valves, 13 prosthetic valves, and 2 corrected valves due to Ozaki procedure, along with a central shunt and 4 pacemaker leads. As a single test, the sensitivity and specificity of CCT, TTE, and TEE for valvular lesions were 91.6/20%, 65.5/57.9%, and 60/84%, and paravalvular lesions were 100/0%, 46/10.5%, and 14.7/100%. When combined together, sensitivity and specificity for valvular lesions rose to 96.6/0% and paravalvular lesions to 100/0%. We also analyzed the diagnostic performance for each test in single and mutual application, per specific IE lesion. In the individual application, CCT in comparison to TTE and TEE shows better diagnostic performance in detection of valvular and paravalvular lesions. In joint application, there is a statistically significant difference in performance compared to their single use, especially in prosthetic valves and invasive forms of IE native valves.

Epair of severe aortic insufficiency and stenosis after Ozaki surgery with Perceval™ sutureless aortic valve

The Ozaki technique is a novel technique which involves constructing a new aortic valve with autologous pericardium. The Perceval™ aortic valve is a foldable, stent-inserted aortic valve bioprosthesis that can be placed seamlessly. In a 58-year-old female patient who previously underwent the Ozaki procedure, severe aortic regurgitation and aortic valve stenosis were observed and surgical repair was performed using a Perceval™ valve. Only a trace amount of paravalvular aortic regurgitation was detected in the control echocardiography. The patient was uneventfully discharged five days after the operation. In conclusion, aortic valve replacement with the Perceval™ valve after the Ozaki procedure is an alternative that should be kept in mind in selected cases.

Ross procedure versus pulmonary homograft versus mechanical valve versus bioprosthetic valve versus Ozaki procedure for surgical aortic valve replacement: a frequentist network meta-analysis

BackgroundThere has been a resurgence in interest regarding the Ross procedure due to recent publications detailing positive long-term outcomes. Conversely, surgical aortic valve replacement (SAVR) with a pulmonary homograft (PH), mechanical (MV), bioprosthetic (BV), or the Ozaki procedure each has its own technical advantages and disadvantages. Therefore, we performed a network meta-analysis (NMA) comparing other alternatives to Ross procedure.MethodsMedical databases were comprehensively searched for studies comparing the Ross procedure with AVR using a PH, MV, BV, or the Ozaki procedure. Outcomes were pooled as risk ratios (RR) with their 95% confidence intervals (95% CI).ResultsA total of 7816 patients were pooled for our NMA from 24 studies. Compared to Ross procedure, both BV and MV were associated with significantly higher rates of 30-day mortality of RR (2.37, 95% CI 1.20–4.67) and (1.88 95% CI 1.04–3.40), respectively, with no significant difference regarding PH or Ozaki. However, only MV was associated with a higher risk of 30-day stroke (RR 8.42, 95% CI 1.57–45.23) with no significant difference in the other alternatives, as well as 30-day MI which showed no significant differences between any of the aortic conduits compared to the Ross procedure. Regarding 30-day major bleeding, MV was associated with a higher when compared to the Ross procedure RR (4.58, 95% CI 1.94–10.85), PH was associated with a lower risk of major bleeding with RR (0.35, 95% CI 0.17–0.71), and BV showed no significant difference. With a mean follow-up duration of 8.5 years compared to the Ross procedure, BV, PH, and MV were associated with a higher risk of long-term mortality with RR (1.89, 95% CI 1.38–2.58), (1.38, 95% CI 1.0–1.87), and (1.94, 95% CI 1.52–2.47), respectively, with the Ozaki procedure showed no significant difference. Regarding long-term stroke—with a mean of 6.3-year follow-up duration—there were no significant differences between any of the aortic conduits compared to the Ross procedure. Nevertheless, long-term need for reintervention—with a mean follow-up duration of 17.5 years—was significant of higher risk with both BV and PH with RR (3.28, 95% CI 1.21–8.84) and (2.42, 95% CI 1.05–5.58), respectively, compared to Ross procedure with MV and Ozaki having no significant difference.ConclusionsThe Ross procedure is a viable treatment option for patients undergoing SAVR, showing promising outcomes at short- and long-term follow-ups.

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

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.

Aortic Valve Reinterventions after Ozaki: Clinical Case Series from Four Centers

Introduction. One of surgical methods for treatment of aortic valve (AV) pathology is Aortic Valve Neocuspidalization Ozaki procedure (AVNeo). Thus, according to the latest systematic review, freedom from reoperation within one, three, five years after AVNeo was 98%, 97% and 96%. Available references provide few descriptions of reoperations after AVNeo. Aim. To analyze the immediate results of AV reinterventions after AVNeo. Materials and methods. In the medium term, reinterventions after AVNeo were necessary for 11 patients (4.3%). The age of patients ranged from 26 to 69 years. 11 patients who underwent surgery included 6 males and 5 females. Four patients had class III-IV CHF, according to NYHA classification. Three patients had previously been operated on for infective endocarditis (IE), and five patients had bicuspid aortic valve. The duration of follow-up, from AVNeo surgery to reinterventions, ranged from 3 to 43 months. Results and discussion. All patients underwent an isolated AV intervention. The main causes of dysfunction were IE (six patients) and leaflet rupture in the commissural area (five patients). Seven patients underwent aortic valve replacement with mechanical valves, one patient — with aortic homograft valve, one patient — with tissue valve and two patients underwent valve repair. In the early postoperative period, one patient had bleeding with the development of cardiac tamponade and one patient had a haemorrhagic stroke. No patients had ARF, perioperative myocardial damage, sternal infection or permanent pacemaker implantation. Two patients died during the hospital period. Conclusions. AV reinterventions are associated with a high incidence of complications and deaths. Therefore, prevention of IE and commissure enhancement should reduce the frequency of repeated interventions, which is to be confirmed by prospective studies in large cohorts of patients.

Aortic valve surgery in the pediatric population: pathophysiology, clinical features and management.

There are several conditions where the function of the aortic valve can be compromised in the pediatric population. The aortic valve is composed of three leaflets which are thin and mobile and are attached to the aortic sinuses. Each leaflet is made up of connective tissue, forming a highly ordered network of extracellular matrix components. Together, this enables the aortic valve to open and close more than 100,000 times throughout the day. However, there are conditions where the structure of the aortic valve can be compromised resulting in its function being affected. Conditions such as congenital valvular aortic stenosis and abnormal valve morphology including bicuspid valves often necessitate intervention to improve symptoms and quality of life in children. Other conditions which result in requiring surgical intervention include infective endocarditis and trauma. In this article, we present the common forms of aortic valve disease in the pediatric population and the clinical presentation and pathophysiology of these. We also discuss the range of management options including medical management and percutaneous intervention. Surgical interventions such as Aortic annular enlargement techniques, the Ross procedure and the Ozaki procedure will also be discussed. The effectiveness, complications and long-term outcomes associated with these methods will be explored.

Aortic Valve Reconstruction With Autologous Pericardium Versus a Bioprosthesis: The Ozaki Procedure inPerspective.

Background We assessed the Ozaki procedure, aortic valve reconstruction using autologous pericardium, with respect to its learning curve, hemodynamic performance, and durability compared with a stented bioprosthesis. Methods and Results From January 2007 to January 2016, 776 patients underwent an Ozaki procedure at Toho University Ohashi Medical Center. Learning curves, aortic regurgitation (AR), and peak gradient, assessed by serial echocardiograms, valve rereplacement, and survival were investigated. Valve performance and durability were compared with 627 1:1 propensity-matched patients receiving stented bovine pericardial valves implanted from 1982 to 2011 at Cleveland Clinic. Learning curves were observed for aortic clamp and cardiopulmonary bypass times, AR prevalence, and early mortality. Decreased aortic clamp time was observed over the first 300 cases. New surgeons performing parts of the procedure after case 400 resulted in a slight increase in aortic clamp and cardiopulmonary bypass times. Among matched patients, the Ozaki cohort had more AR than the PERIMOUNT cohort (severe AR at 1 and 6 years, 0.58% and 3.6% versus 0.45% and 1.0%, respectively; P[trend]=0.006), although with a steep learning curve. Peak gradient showed the opposite trend: 14 and 17 mm Hg for Ozaki and 24 and 28mm Hg for PERIMOUNT at these times (P[trend]<0.001). Freedom from rereplacement was similar (P=0.491). Survival of the Ozaki cohort was 85% at 6years. Conclusions Patients undergoing the Ozaki procedure had lower gradients but more recurrent AR than those receiving PERIMOUNT bioprostheses. Although recurrent AR is concerning, results confirm low risk and good midterm performance of the Ozaki procedure, supporting its continued use.

Ozaki procedure

Background and aim Mechanical heart valves require lifelong anticoagulation and therefore predispose to hemorrhagic events. Ozaki developed their aortic valve (AV) reconstruction technique at Toho University Ohashi Medical Center, where they standardized the use of glutaraldehyde-treated autologous pericardium to perform a trileaflet aortic valve. Therefore, it achieves maximum effective orifice area (EOA) and low transvalvular gradients. The current study aimed to assess the short-term Ozaki procedure in our center. Patients and methods A total of 86 patients were enrolled in the current study; group A included 43 patients who had undergone AVR using a biological aortic valve prosthesis, and group B included 43 patients who had undergone aortic valve replacement (AVR) using the Ozaki procedure. Results Both groups had comparable findings either at baseline, perioperative data, or during the follow-up. During follow-up either in the 3rd or 6th month both groups had insignificant differences. Renal dysfunction was reported in five (11.6%) patients of the biological valve group and two patients of the Ozaki group. Endocarditis was developed in only two patients with biological valves. Mild aortic regurgitation was noticed in one patient in the 3rd month and two patients in the 6th month in the case of the Ozaki procedure, while only one patient in the biological valve group developed mild AR in the 6th month of follow-up. Nearly all patients had improved NYHA classes in both groups. No patient in the Ozaki group was converted to AVR. Conclusion We have described our initial experience with the Ozaki procedure in adults. The current study reported promising results for the Ozaki procedure. Yet, multiple future studies in multiple centers are warranted to draw a firm conclusion and support our findings.

Беременность и роды после неокуспидализации аортального клапана аутологичным перикардом: альтернативное решение, не требующее антикоагулянтной терапии

With the development of cardiac surgery, more and more women with congenital heart disease undergo cardiac interventions and reach reproductive age. Therefore, the number of pregnant patients with significant cardiac pathology is increasing. This article presents a clinical case of successful surgical treatment of aortic stenosis (the Ozaki procedure) in a 31-year-old woman who subsequently became pregnant and delivered a child. Conclusion. Despite the debate among cardiac surgeons, the Ozaki procedure can be considered as a viable option for aortic valve replacement in women with the prospect of pregnancy and childbirth. However, a larger study in this population is needed. Key words: aortic valve, aortic stenosis, aortic valve neocuspidization with autologous pericardium, aortic valve replacement, Ozaki procedure, pregnancy

Predictors of Mid-Term AVNeo Insufficiency.

Aortic stenosis (AS) is the most common valvular heart disease and the most common indication for aortic valve replacement in adults. Aortic valve neocuspidization (AVNeo) with fixed autologous pericardium, also known as the Ozaki procedure, is a possible alternative treatment of AS. Autopericardial valves save the dynamics and physiological anatomy of the aortic root, however, the service life of autopericardial leaflets is limited. There is no data about factors that may influence the development of AVNeo insufficiency. Here, we assessed the effect of autopericardial leaflet symmetry on the development of aortic insufficiency after Ozaki procedure. This study included 381 patients with AS who underwent Ozaki procedure. Patients were divided into group 1 (171 patients with symmetric aortic root) and group 2 (210 patients with asymmetric aortic root). The maximum observation period was up to 65 months. Sixteen cases of aortic insufficiency were detected in group 1, and 33 cases were detected in group 2. Based on the results of Cox regression, the predictors of aortic insufficiency in the late postoperative period are age and asymmetry of neocusps. According to results of Kaplan-Meier analysis, insufficiency of AVNeo in the maximum follow-up period after surgical correction of AS for group 1 patients was significantly lower than for group 2 patients (P=0.006). Asymmetric neocusps increase the risk of aortic insufficiency in the mid-term period after Ozaki procedure. And the older the patients at the time of surgery, the less likely they develop AVNeo insufficiency.

A Case of Severe Aortic Stenosis after Aortic Valve Neocuspidization Using Autologous Pericardium (Ozaki Procedure).

A 56-year-old man with a history of left nephrectomy for Wilms' tumor on chronic hemodialysis underwent aortic valve neocuspidization using autologous pericardium (Ozaki procedure) for aortic stenosis (AS) due to a bicuspid aortic valve 6 years ago. The AS gradually progressed and a decrease in the left ventricular ejection fraction was observed. Because of this, we decided to perform reoperative aortic valve replacement using a mechanical valve. Intraoperative findings showed severe calcification at the site where the autologous pericardium was sutured to the annulus. However, the degeneration of the valve leaflets themselves was mild. While excellent mid-term results have been reported for the Ozaki procedure, the long-term results are still unclear. In this case, the annulus was severely calcified, which reduced the mobility of the leaflet. We report the first case of AS progression requiring reoperation in the long-term period after the Ozaki procedure.

Immediate and long-term results of aortic valve replacement with biological prosthesis and Ozaki procedure in patients with severe aortic stenosis, reduced ejection fraction and low transaortic pressure gradient

Immediate and long-term results of aortic valve replacement with biological prosthesis and Ozaki procedure in patients with severe aortic stenosis, reduced ejection fraction and low transaortic pressure gradient

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. 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). 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. A comprehensive literature search was performed using multiple electronic databases including PubMed, Ovid, Embase, and Scopus to collate the relevant research evidence. 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. 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.

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

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. 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. 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% ofpatients' native AV was bicuspid. Three studies reported their experience performing AV Neo via ministernotomy. 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.

Ex vivo evaluation of the Ozaki procedure in comparison with the native aortic valve and prosthetic valves.

OBJECTIVESWe investigated the hydrodynamic performance and cusp kinematics of the Ozaki neocuspidized aortic valve in comparison with the native aortic and prosthetic valves in an ex vivo study.METHODSNative aortic valves of swine hearts were replaced by aortic valve substitutes, and their hydrodynamic performance (effective orifice area and mean pressure gradient) was evaluated in a mock circulation under defined conditions. The following aortic valve substitutes were investigated: native aortic valve, Ozaki valve, Perimount Magna Ease, Trifecta and St. Jude Medical Masters. All prosthetic valves had a labelled size of 21 mm.RESULTSThe Ozaki valve and native aortic valve showed a similar and significantly larger orifice area than all investigated prosthetic valves particularly at high flow rates. There was no significant difference between the Ozaki valve and the native aortic valve. The native aortic valve and Ozaki valve showed a similar increase in orifice area with increasing flow through the valve while prosthetic valves showed a markedly weaker increase. Similarly, the native and Ozaki valve showed a similar increase in mPG with forward flow which was weaker than prosthetic valves. Cusp kinematics were similar between the native and Ozaki valve, whilst prosthetic valves were clearly distinguishable from them.CONCLUSIONSThe Ozaki procedure showed excellent hydrodynamic performance compared to prosthetic valves and showed similar cusp motion characteristics to the native aortic valve. Our results suggest that the Ozaki neocuspidized valve behaves physiologically in many aspects, which may contribute to beneficial clinical outcomes.

Aortic valve neocuspidization using autologous pericardium compared to surgical aortic valve replacement.

Aortic valve neocuspidization (AVNeo) for trileaflet aortic valve reconstruction using autologous pericardium (Ozaki procedure) depicts an encouraging new technique for the surgical treatment of aortic valve pathologies. The current study analyzes the early hemodynamic outcome of AVneo compared with surgical aortic valve replacement (SAVR) using the Abbott/St. Jude Trifecta aortic valve biological prostheses. All patients who underwent either AVNeo or SAVR between March 2017 and April 2020 were included. Exclusion criteria were emergency cases, endocarditis, redo- or additional root procedures. Main endpoints were differences between the two groups in terms of the effective orifice area (EOA) and the effective orifice area index (EOAI) at discharge. During the study period, 105 AVNeo patients and 458 SAVR patients met the inclusion criteria. EOA was significantly higher in the AVNeo group (2.4 cm2 ± 0.8 vs. 2.1 cm2 /m2 ± 0.6 in the SAVR group, respectively; p < .001). Multiple regression analysis, including AVNeo, annulus size, bicuspid valve, preoperative stenosis, left ventricular ejection fraction (LVEF), and diastolic diameter (LVEDD) found two factors, which favor larger EOA: Annulus size (p < .0001) and AVneo (p = .005). EOAI was significantly higher in the AVNeo group (1.23 ± 0.4 vs. 1.02 cm2 /m2 ± 0.3, respectively; p < .001). Multiple regression analysis for EOAI showed effects for AVneo (p = .005) and bicuspid valve (p = .029). Mean pressure gradients (MPG) were lower in the AVNeo group than in the SAVR group (AVNeo: MPG = 8.0 mmHg ± 3.6 vs. SAVR: MPG = 8.3 mmHg ± 3.6), but this finding did not reach statistical significance (p = .091). AVNeo shows significantly larger EOA and EOAI compared to SAVR using the Abbott/St. Jude Trifecta aortic valve biological prostheses.

Method of intraoperative transesophageal echocardiography during the Ozaki procedure (Clinical case)

Modern imaging techniques including various echocardiographic technologies have become firmly established in the practice of cardiac surgery. The method of intraoperative transesophageal echocardiography (TEE) is of particular significance for ensuring the safety of patients during open heart surgery. This method is necessary for performing reconstructive interventions on the valve apparatus of the heart in patients with initial myocardial dysfunction to assess the anatomical and functional state of the heart and its structures at all stages of surgical treatment. Information obtained in the operation room using TEE allows the surgeon to choose the optimal tactics of surgical intervention, evaluate the results of surgery, and predict the course of early postoperative period. The presented clinical case demonstrates the capabilities of intraoperative use of TEE during the Ozaki procedure in a patient with congenital bicuspid aortic valve.

Analysis of cardiac conduction disorders in adult patients in the early postoperative period after Ozaki surgery

Purpose. To assess the disorders of the cardiac conduction system (CCS) that occurred in the early postoperative period after aortic valve (AV) replacement by the Ozaki method.Methods. The study included 256 patients after a successfully performed Ozaki procedure. Patients with a history of open cardiac surgery, with an implanted pacemaker, with permanent atrial fibrillation, with simultaneous Ozaki surgery with correction of another pathology, in case of repeated surgery on AV in the next six months, with lethal outcome, under the age of 18 years, when it is impossible to analyze the CCS dynamics were excluded. The mean age was 57.9±11.1 years, the male sex was 119 people (46.5%), the body mass index was 29.7±5.5 kg/m2 , diabetes was observed in 40 patients (15.6%), anamnesis of CCS disorders in 10 (3.9%), CCS disorders on the baseline electrocardiogram (ECG) in 32 (12.5%). Conduction abnormalities were assessed according to the anamnesis and the results of daily ECG recording.Results. In the early postoperative period, CCS disorders were registered in 35 patients (13.7%), of whom 27 (10.6%) had their first occurrence, and 8 (3.1%) had previously existed. By the time of discharge, persistent CCS disorders (which occurred for the first time and in the case of progression of pre-existing blocks) remained in 11 (4.3%): 8 (3.1%) had bundle branch blocks, 3 (1.2%) had atrioventricular blocks that required implantation of a permanent pacemaker. Patients with pacemaker had initial conduction abnormalities. The most frequent dysfunction of the CСS was the left bundle branch block (LBBB) (45.5%). We analyzed 14 variables as predictors of the onset or progression of persistent CCS disorders. Two independent predictors were identified - the presence of conduction abnormalities on the baseline ECG and the time of cardiopulmonary bypass. In patients with persistent conduction disturbances in the postoperative period, CCS disorders on the baseline ECG were more common - 36.4% compared with patients without CCS disorders after surgery - 11.4% (p=0.035) and there was a longer duration of cardiopulmonary bypass 140.6±41.1 min. and 122.4±26.1 min. respectively (p=0.03).Conclusion. The most frequent disorder of the conduction was the LBBB. None of the first dysfunctions of CCS led to the implantation of the pacemaker. The presence of initial ECG conduction disturbances and the time of cardiopulmonary

Aortic valve neocuspidization and its technical nuance.

Aortic valve neocuspidization or Ozaki procedure represents an advanced surgical strategy for the management of patients with aortic valvulopathy. It has been shown to have clinical and hemodynamic outcomes that compare favorably with aortic valve replacement as it restores physiological aortic valve function and left ventricular remodeling. There are, however, a new set of issues including structural valve deterioration, leaflet tear/perforation, and need for reoperation. A keen understanding of the technical nuances involved with the Ozaki procedure may help in reducing the incidence of such adverse outcomes.