Background: Aortic neo-cuspidization (AVNeo) procedure has been adopted by limited
centers with the publication of the mid-long term successful results. The aim of this study was to present initial experience of the
AVNeo procedure of a single center.Methods: The medical records of 24 patients who underwent AVNeo with or without
concomitant cardiac surgery between February 2019 and February 2021 at our
tertiary hospital were scanned retrospectively. Results: The mean age of
patients was aged 58.21 ± 13.14 years and 16
(66.7%) of them were men. 16 patients were operated on for aortic stenosis
(66.67%). Morphology of the aortic valve was tricuspid in 21 (87.5%) and bicuspid in 3 (12.5%) of the patients. Additional
cardicac surgery was performed in 13 (54.17%) patients. No patients
needed reoperation for bleeding, pacemaker
implantations, conversion to classical prosthetic aortic valve replacement, or infective endocarditis. Two patients died due to non-cardiac reasons. Preoperative peak and mean aortic valve pressures improved
significantly at 1st and 6th months (Preop:89.06 ± 21.88 mmHg and
56.38 ± 15.09 mmHg 1st month:
22.00 ± 3.93 mmHg and 8.73 ± 2.60 mmHg, 6th month: 18.13 ±
3.02 mmHg and 6.93 ± 1.83 mmHg). Conclusion: In conclusion, the AVNeo procedure is
a feasible technique for aortic valve pathologies, with the advantages
of avoiding anticoagulants and the applicability of concomitant surgical procedures. Although this procedure requires
meticulous experience, results similar to the available published
literature can be obtained and
References
[1]
Duran, C.M., Gometza, B., Kumar, N., Gallo, R. and Martin-Duran, R. (1995) Aortic Valve Replacement with Freehand Autologous Pericardium. The Journal of Thoracic and Cardiovascular Surgery, 110, 511-516. https://doi.org/10.1016/S0022-5223(95)70248-2
[2]
Ozaki, S., Kawase, I., Yamashita, H., Uchida, S., Nozawa, Y., Matsuyama, T., et al. (2011) Aortic Valve Reconstruction Using Self-Developed Aortic Valve Plasty System In Aortic Valve Disease. Interactive Cardiovascular and Thoracic Surgery, 12, 550-553. https://doi.org/10.1510/icvts.2010.253682
[3]
Ozaki, S., Kawase, I., Yamashita, H., Uchida, S., Nozawa, Y., Takatoh, M., et al. (2014) A Total of 404 Cases of Aortic Valve Reconstruction with Glutaraldehyde-Treated Autologous Pericardium. The Journal of Thoracic and Cardiovascular Surgery, 147, 301-306. https://doi.org/10.1016/j.jtcvs.2012.11.012
[4]
Ozaki, S., Kawase, I., Yamashita, H., Uchida, S., Nozawa, Y., Takatoh, M., et al. (2014) Aortic Valve Reconstruction Using Autologous Pericardium for Ages over 80 Years. Asian Cardiovascular and Thoracic Annals, 22, 903-908. https://doi.org/10.1177/0218492314520748
[5]
Ozaki, S., Kawase, I., Yamashita, H., Uchida, S., Takatoh, M., Hagiwara, S., et al. (2015) Aortic Valve Reconstruction Using Autologous Pericardium for Aortic Stenosis. Circulation Journal, 79, 1504-1510. https://doi.org/10.1253/circj.CJ-14-1092
[6]
Ozaki, S., Kawase, I., Yamashita, H., Uchida, S., Takatoh, M. and Kiyohara, N. (2018) Midterm Outcomes after Aortic Valve Neocuspidization with Glutaraldehyde-Treated Autologous Pericardium. The Journal of Thoracic and Cardiovascular Surgery, 155, 2379-2387. https://doi.org/10.1016/j.jtcvs.2018.01.087
[7]
Mooney, J., Sellers, S. L., Blanke, P., Pibarot, P., Hahn, R. T., Dvir, D., et al. (2017) CT-Defined Prosthesis-Patient Mismatch Downgrades Frequency and Severity, and Demonstrates No Association with Adverse Outcomes after Transcatheter Aortic Valve Replacement. JACC: Cardiovascular Interventions, 10, 1578-1587. https://doi.org/10.1016/j.jcin.2017.05.031
[8]
Zorn, G.L., Little, S.H., Tadros, P., Deeb, G.M., Gleason, T.G., Heiser, J., et al. (2016) Prosthesis-Patient Mismatch in High-Risk Patients with Severe Aortic Stenosis: A Randomized Trial of a Self-Expanding Prosthesis. The Journal of Thoracic and Cardiovascular Surgery, 151, 1014-1023. https://doi.org/10.1016/j.jtcvs.2015.10.070
[9]
Ghanta, R.K. and Kron, I.L. (2016) Patient-Prosthesis Mismatch: Surgical Aortic Valve Replacement Versus Transcatheter Aortic Valve Replacement in High Risk Patients with Aortic Stenosis. Journal of Thoracic Disease, 8, E1441-E1443. https://doi.org/10.21037/jtd.2016.09.62
[10]
Meuris, B., Ozaki, S., Neethling, W., De Vleeschauwer, S., Verbeken, E., Rhodes, D., et al. (2016) Trileaflet Aortic Valve Reconstruction with a Decellularized Pericardial Patch in a Sheep Model. The Journal of Thoracic and Cardiovascular Surgery, 152, 1167-1174. https://doi.org/10.1016/j.jtcvs.2016.05.024
[11]
Bjoerk, V.O. and Hultquist, G. (1964) Teflon and Pericardial Aortic Valve Prostheses. The Journal of Thoracic and Cardiovascular Surgery, 47, 693-701. https://doi.org/10.1016/S0022-5223(19)33497-X
[12]
Bahnson, H.T., Hardesty, R.L., Baker, L.D., Jr., Brooks, D.H. and Gall, D.A. (1970) Fabrication and Evaluation of Tissue Leaflets for Aortic and Mitral Valve Replacement. Annals of Surgery, 171, 939-947. https://doi.org/10.1097/00000658-197006010-00015
[13]
Ross, D.N. (1963) Surgical Reconstruction of the Aortic Valve. Lancet, 281, 571-574. https://doi.org/10.1016/S0140-6736(63)92687-4
[14]
Senning A. (1967) Fascia Lata Replacement of Aortic Valves. The Journal of Thoracic and Cardiovascular Surgery, 54, 465-470. https://doi.org/10.1016/S0022-5223(19)43054-7
[15]
Kumar, S.P., Prabhakar, G., Kumar, M., Kumar, N., Shahid, M., Ali, M.L., et al. (1995) Comparison of Fresh and Glutaraldehyde-Treated Autologous Stented Pericardium as Pulmonary Valve Replacement. Journal of Cardiac Surgery, 10, 545-551. https://doi.org/10.1111/j.1540-8191.1995.tb00630.x
[16]
Jayakrishnan, A. and Jameela, S.R. (1996) Glutaraldehyde as a Fixative in Bioprostheses and Drug Delivery Matrices. Biomaterials, 17, 471-484. https://doi.org/10.1016/0142-9612(96)82721-9
[17]
Kawase, I., Ozaki, S., Yamashita, H., Uchida, S., Nozawa, Y., Matsuyama, T., et al. (2012) Aortic Valve Reconstruction of Unicuspid Aortic Valve by Tricuspidization Using Autologous Pericardium. The Annals of Thoracic Surgery, 94, 1180-1184. https://doi.org/10.1016/j.athoracsur.2012.05.016
[18]
Ozaki, S., Kawase, I., Yamashita, H., Nozawa, Y., Takatoh, M., Hagiwara, S. et al. (2014) Aortic Valve Reconstruction Using Autologous Pericardium for Patients Aged Less Than 60 Years. The Journal of Thoracic and Cardiovascular Surgery, 148, 934-938. https://doi.org/10.1016/j.jtcvs.2014.05.041
[19]
Arutyunyan, V., Chernov, I., Komarov, R., Sinelnikov, Y., Kadyraliev, B., Enginoev, S., et al. (2020) Immediate Outcomes of Aortic Valve Neocuspidization with Glutaraldehyde-Treated Autologous Pericardium: A Multicenter Study. Brazilian Journal of Cardiovascular Surgery, 35, 241-248. https://doi.org/10.21470/1678-9741-2020-0019
[20]
Ozaki S. (2019) Ozaki Procedure: 1,100 Patients with Up to 12 Years of Follow-Up. Turk Gogus Kalp Damar Cerrahisi Dergisi, 27, 454 p. https://doi.org/10.5606/tgkdc.dergisi.2019.01904
[21]
Iida, Y., Fujii, S., Akiyama, S. and Sawa, S. (2018) Early and Mid-Term Results of Isolated Aortic Valve Neocuspidization in Patients with Aortic Stenosis. General Thoracic and Cardiovascular Surgery, 66, 648-652. https://doi.org/10.1007/s11748-018-0976-0
[22]
Krane, M., Boehm, J., Prinzing, A., Ziegelmueller, J., Holfeld, J. and Lange, R. (2021) Excellent Hemodynamic Performance after Aortic Valve Neocuspidization Using Autologous Pericardium. The Annals of Thoracic Surgery, 111, 126-133. https://doi.org/10.1016/j.athoracsur.2020.04.108
[23]
Yamamoto, Y., Iino, K., Shintani, Y., Kato, H., Kimura, K., Watanabe, G., et al. (2017) Comparison of Aortic Annulus Dimension after Aortic Valve Neocuspidization with Valve Replacement and Normal Valve. Seminars in Thoracic and Cardiovascular Surgery, 29, 143-149. https://doi.org/10.1053/j.semtcvs.2016.11.002
[24]
Wiggins, L.M., Mimic, B., Issitt, R., Ilic, S., Bonello, B., Marek, J., et al. (2020) The Utility of Aortic Valve Leaflet Reconstruction Techniques in Children and Young Adults. The Journal of Thoracic and Cardiovascular Surgery, 159, 2369-2378. https://doi.org/10.1016/j.jtcvs.2019.09.176