174. Outcome of 1196 Aortic Valve Reconstruction – The Ozaki Procedure

Objective: Introduced in 2007, aortic valve reconstruction with autologous pericardium --Ozaki procedure--has become an attractive option for aortic valve replacement. Multiple studies have demonstrated good short-term outcomes. In this longest-term and most detailed single-institution study of the Ozaki procedure, our objective was to investigate the intermediate term results after the Ozaki procedure.
Methods: From 4/2007 to 5/2021, 1,196 consecutive Ozaki procedures were performed. Patient age ranged from 11 to over 90 years, 712 (60%) were male, 50 (4.2 %) had previous cardiac surgery, and 155 (13%) were on dialysis. 651 (54%) had pure aortic stenosis, 289 (24%) pure regurgitation and 87 (7.2%) mixed stenosis and regurgitation. 322 (27%) had bicuspid valves and 28 (2.3%) infective endocarditis. Concomitant procedures were performed in 551 (46%). Complications, serial postoperative echocardiogram data, and follow-up information on aortic valve reoperations and mortality were collected and analyzed by multivariable longitudinal data analyses for valve performance, and time-to-event analyses for reoperation and mortality. Fifty percent of patients (n=598) were followed more than 3.2 years for these events and changes, 10% (n=119) more than 9 years; 5,023 patient-years of follow-up were available for analysis.
Results: Mean Cardiopulmonary bypass and aortic clamp time for isolated Ozaki procedures were 151+/-37 and 105+/-29 minutes, respectively. Operative mortality was 4.6% (n=55), postoperative stroke 2.6% (n=31), new dialysis 4.0% (41/1,035), new heart block 1.5% (18/1,188). At 6 months, 5 years, and 10 years, peak/mean aortic valve gradients were 14.0/7.4, 15.5/8.0, and 15.5/8.2 mmHg (figure); moderate or severe aortic regurgitation was 0.30%, 2.9%, 6.6%, respectively. LV mass index decreased from 141+/-52 g/m2 preoperatively to estimated 100+/- 1.1 g/m2 at 6 months and 90+/-1.8 g/m2 at 10 years. There were 38 reoperations, 17 for infective endocarditis. Freedom from reoperation was 91.2% at 10 years. 166 deaths, including 19 (11%) cardiac deaths were observed. Survival was 75% at 10 years.
Conclusions: The Ozaki procedure creates a good aortic valve with low stable gradients up to at least 10 years. Aortic regurgitation increased over time, but risk of reoperation was low. These results support the continued use of the Ozaki procedure for aortic valve replacement for any unrepairable valve pathology.

Shinya Unai (1), Shigeyuki Ozaki (2), Yasuhiro Hoshino (1), Serge C. Harb (1), Hiromasa Hayama (2), Mikio Takatoo (2), Nagaki Kiyohara (2), Hiroshi Kataoka (2), Lars Svensson (1), Jeevanantham Rajeswaran (1), Eugene Blackstone (1), Gosta Pettersson (1), (1) Cleveland Clinic, Cleveland, OH, (2) Toho University Ohashi Medical Center, Meguro-ku, Tokyo

Ismail El-Hamamsy

Invited Discussant

Ismail El-Hamamsy, MD PhD

Ismail El-Hamamsy, MD, PhD, FRCSC, is System Director of Aortic Surgery at the Mount Sinai Health System and is honored to serve as Mount Sinai’s inaugural Randall B. Griepp Professor of Surgery. His principal surgical focus is aortic root reconstructive surgery in young adults, including patients with heritable and connective tissue disorders.

Before joining Mount Sinai, Dr. El-Hamamsy directed the Montreal Heart Institute’s aortic surgery program, one of the busiest complex aortic surgery programs in North America, and was Associate Professor at the University of Montreal. He founded the Montreal Heart Institute’s Aortic and Connective Tissue Clinics, and helped establish several Ross programs across North America, Europe and Asia. Altogether, he has performed more than 700 Ross procedures and valve-sparing operations, which are among the world’s most complex and challenging aortic surgeries.

Dr. El-Hamamsy completed his medical education and cardiac surgery training at the University of Montreal, followed by a 4-year fellowship in London under the mentorship of Sir Magdi Yacoub. During this period, he completed a PhD entitled “The Living Aortic Valve” at Imperial College London. He currently leads a research team exploring the natural history of aortic disease, as well as innovative therapeutic approaches to diseases of the aorta and aortic valve.    

Dr. El-Hamamsy has authored or co-authored several book chapters, as well as more than 150 scientific articles in The Lancet, Circulation, JACC and other leading peer-reviewed journals. He serves on the Editorial Boards of The American Heart Journal, Journal of Heart Valve Disease, Structural Heart and the Canadian Journal of Cardiology, and is an elected member of the American Association for Thoracic Surgery.  He also serves on the Heart Valve Society’s Board of Directors, and – among other humanitarian projects – helped establish the Aswan Heart Center in Egypt.

 

 

 

 

Shinya Unai

Abstract Presenter

Shinya Unai, MD, is a staff surgeon, and Surgical Director of the Endocarditis Center in the Cleveland Clinic Department of Thoracic and Cardiovascular Surgery. He is certified by the Japanese Boards of Cardiovascular Surgery. 

Dr. Unai received his medical degree from Tokyo University, Japan.  He completed residencies in general surgery and cardiovascular surgery at Mitsui Memorial Hospital, Tokyo. Dr. Unai continued his specialty training as a cardiovascular surgery fellow at Thomas Jefferson University, Philadelphia PA. He completed his training as a clinical associate in minimally invasive, complex adult cardiac surgery, heart/lung transplantation and aortic surgery at Cleveland Clinic. He was appointed to Cleveland Clinic in 2017.

Dr. Unai has published over 70 book chapters and articles in peer-reviewed journals. His research is focused on endocarditis, complex valve disease and heart/lung failure. He also has made numerous presentations at major medical meetings in the United States, Europe and Japan.

Specialties: Adult Cardiac, Aortic Valve, Anatomy and Conditions, Valve, Aortic Valve, Treatment/Procedure/Operation/Surgery, Valve, Aortic valve