Efendiev V., Noginov V., Snegirev M., Golovacheva E., Minin E., Girfanov A.

Ozaki procedure: How many cusps are better?

Objective. To compare the results of the Ozaki operation from a L-ministernotomy using three and two autopericardial neocusps.

Methods. From June 2020 to June 2024, 178 operations on the aortic root and/or aortic valve were performed in the Department of Cardiac Surgery at the Mariinsky Hospital. Aortic valve replacement using the Ozaki technique was performed in 81 patients, 69 of them from L-ministernotomy. In all cases, the CPB connection was central, and the autopericardium was taken from a L-ministernotomy access. Hemodynamic parameters were assessed using echocardiography at the hospital stage at discharge and on an out patient basis after 6 months, then 1 time per year.

Results. The patients were divided into 2 groups: 48 patients in group I with 3 neocusps, 21 patients in group II with 2 neocusps. The average age of patients in group I was 70.4 ± 4.45 years, in group II – 58.4 ± 11.3 years (p<0.05). The patient groups were comparable in terms of risk factors, quantitative echocardiographic parameters, and concomitant pathology. Cardio-pulmonary bypass (CPB) time and aortic clamping in group I was 167.5 ± 52 minutes and 101.6 ± 15.2 minutes, respectively, and in group II – 128.4 ± 21.7 and 87.4 ± 14.7 minutes, respectively (p< 0.05). The average gradient on AVNeo at discharge in group I was 7.2 ± 3.02 mmHg in group II – 6.5 ± 3.38 mmHg, and in the long–term period in group I – 7.8 ± 3.41 mmHg, in group II 7.4 ± 4.4 mmHg. The average follow-up period in group I was 28.9 ± 5.43 months, and in group II – 30.0 ± 7.43 months. During the entire period of observation of patients in both groups, aortic insufficiency (AI) was not more than 1. Hospital mortality: in group I – 1 patient due to the development of nosocomial pneumonia. In the long-term period, 1 re-operation was performed on a patient from group II, after 14 months AVNeo infectious endocarditis was developed, and an aortic allograft was performed.

Conclusion: The Ozaki procedure from a ministernotomy using 2 and 3 autopericardial neocusps demonstrates comparable early and medium-term results.