Aortic valve neocuspidization using the Ozaki technique: A meta-analysis of reconstructed patient-level data - 08/12/22

Doi : 10.1016/j.ahj.2022.09.003

Konstantinos S. Mylonas, MD ^a,^⁎,^{^{#
Dr. Mylonas and Dr. Tasoudis have contributed equally and share first authorship.}} , Panagiotis T. Tasoudis, MS ^b,^{^{#
Dr. Mylonas and Dr. Tasoudis have contributed equally and share first authorship.}}, Dionysios Pavlopoulos, MD, PhD ^a, Meletios Kanakis, MD, PhD ^c, George T. Stavridis, MD, FETCS ^a, Dimitrios V. Avgerinos, MD, PhD, FACS, FACC ^a
^a Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
^b Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
^c Department of Pediatric and Adult Congenital Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece

^⁎Reprint requests: Konstantinos S. Mylonas, MD, Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Andrea Syngrou Avenue 356, Athens 17674, Greece.Department of Cardiac SurgeryOnassis Cardiac Surgery CenterAndrea Syngrou Avenue 356Athens17674Greece

Abstract

Background

Aortic valve neocuspidization using the Ozaki technique has shown promising results both in adults and children.

Methods

A systematic search of the PubMed and Cochrane databases was performed up to November 13, 2021. Individual patient data were reconstructed and analyzed from the Kaplan-Meier curves of all eligible studies for time-to-event outcomes.

Results

We included a total of 22 studies reporting on 1,891 patients that underwent Ozaki reconstruction. Mean age at the time of surgery was 43.2 ± 24.5 years (65 ± 12.3 years for adult patients and 12.3 ± 3.8 years for pediatric patients). The most common indication was aortic stenosis (46.4%, 95% CI 34.1-58.6). Mean cross-clamp and cardiopulmonary bypass duration were 106.8 ± 24.8 minutes and 135.2 ± 35.1 minutes, respectively. Permanent pacemaker was implanted in 0.7% (95% CI 0.4-1.2) of the patients. At discharge, mean effective orifice area was 2.1 ± 0.5 cm²/m². At latest follow-up, peak gradient was 15.7 ± 7.4 mm Hg and only 0.25% (95% CI 0-2.3) had moderate aortic insufficiency. In-hospital mortality was 0.7% (95% CI 0.1-1.7). Late mortality was 1.9% during a mean follow-up of 38.1 ± 23.8 months. One-year, 3-year, and 5-year freedom from reoperation rates were 98.0 %, 97.0 % and 96.5%, respectively. More than half of the reoperations were due to infective endocarditis (51.5%, 95% CI 18.3-84.0). In our cohort, the risk of endocarditis per patient per year was 0.5%.

Conclusions

The midterm outcomes of the Ozaki procedure are excellent in terms of hemodynamics, survival, and freedom from reoperation. Acquiring long-term follow-up will help solidify this technique in the cardiac surgery armamentarium.

Le texte complet de cet article est disponible en PDF.