Abstract
Background. Since 2007 more than 2,000 Ozaki procedures (OP) have been undertaken in adults worldwide with the encouraging results. The available results seem to be very promising within the pediatric population. However, data concerning the pediatric groups are scarce and limited for separate clinics. Hence, detailed analysis of all outcomes is eligible to determine the long-term durability of this operation in children.
Material and methods. All patients under 18 years operated with Ozaki method for congenital bicuspid aortic valve (BAV) disease were retrospectively studied from 2017 to 2021. Pre- and postoperative data, including echo, magnetic resonance imaging and computed tomography data were collected and assessed. Follow-up at mid-term period was analyzed.
Results. The median age and weight at surgery were 10 y and 40 kg respectively. Ten (35.7%) patients had concomitant cardiac procedures as mitral plus tricuspid valve repair (n=1) and impinged coronary segment “unroofing” for the intramural course and anomalous arising of the right coronary artery from the left coronary sinus (n=1), pulmonary valve tricuspidization (n=1), aortic arch repair (n=7). Previous transluminal aortic ballooning was performed in 7 cases. OP let to dramatic improvement of the postoperative hemodynamics with significant decreasing of peak and mean gradient across AV for those with predominant aortic stenosis (74.0±17.3 vs 11.5 ± 4.92; p=0.001 и 43.2±11.9 vs 5.14±1.64; p=0.001) and degree of aortic insufficiency for those with predominant AR (AR>2, pre- 14 vs post- 0; p=0.001) which were steady during the follow-up period at mean 24.6 ±13.1 months. In generally, the effective orifice area increased substantially from baseline (1.0 (95% confidencial interval (CI) 1.02–1.76) vs 2.0 (95% CI 1.77–2.3) cm2/m2, p=0.001.
Conclusion. In a selected population of pediatric patients with congenitally diseased BAV, neo-tricucpidalization offers an excellent immediate and short-term outcome. Neo-aortic valve mimics closely the native valve with a minimal impact on hemodynamic performance in children after OP without need of reoperations. However, OP in children requires a long-term follow-up study to address the optimal surgical strategy.
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About the authors
- Aleksey E. Chernogrivov, Dr. Med. Sc., Professor, Head of Department, ORCID
- Igor’ E. Chernogrivov, Dr. Med. Sc., Cardiothoracic Surgeon, ORCID
- Dmitriy A. Bofanov, Cardiothorac Surgeon, ORCID
- Vladlen V. Bazylev, Dr. Med. Sc., Professor, Chief Physician, ORCID
