Abstract
Objective. To analyze the immediate, medium-distant and long-term results of neocuspidalization of the aortic valve using the Ozaki technique in children (under 18 years of age).
Material and methods. From April 2017 to June 2024, 70 surgical interventions of neocuspidalization of the aortic valve according to the Ozaki method were performed in children from 1 to 17 years of age (median age was 10 years) at the Federal Center for Cardiovascular Surgery (Penza). The study included 57 (81.4%) boys and 13 (18.6%) girls. 30 (42.9%) patients had aortic insufficiency, 18 (25.7%) patients had aortic stenosis, and 22 (31.4%) patients had combined aortic malformation. Morphologically, the aortic valve was bicuspid in most patients (n = 58, 82.9%), and tricuspid in the remaining 12 (17.1%). In 48 (68.6%) cases an autopericardium treated with glutaraldehyde was used to create neospores, in 22 (31.4%) cases a xenopericardium manufactured by MedInj (Penza) was used. 20 (28.6%) patients were after previous interventions (balloon valvuloplasty of the aortic valve, plastic surgery of the aortic valve, plastic repair of the ventricular septal defect, resection of the aortic coarctation), the remaining 50 (71.4%) patients were “primary”.
Results. 53 (75.7%) patients underwent isolated neocuspidalization of the aortic valve, 17 (24.3%) patients underwent combined interventions (prosthetics, or plastic surgery of the ascending aorta, plastic surgery of the aortic root, plastic surgery of the pulmonary artery valve, plastic surgery of the mitral and tricuspid valves, suturing of the coronary pulmonary fistula). Access to the heart was carried out through median sternotomy in 69 (98.6%) patients, in 1 (1.4%) patient – through sternotomy. The median time of cardiopulmonary bypass was 135 (88–245) minutes, and the time of myocardial ischemia was 99 (70–160) minutes. There was no hospital fatality. The maximum and average pressure gradients on the aortic valve after surgery were 11 (3–23) mmHg and 5 (1.5–10) mmHg, respectively. There was no regurgitation of more than 1 degree on the Ozaki prosthetic valve. Postcardiotomy syndrome was noted among the complications in 8 (11.4%) patients, bleeding in the early postoperative period that did not require surgical hemostasis in 2 (2.8%) patients. The average long-term results were evaluated after 3 years, the long-term results after 5 years or more. 3 patients required re-surgery for 7 years: one underwent prosthetics with a mechanical prosthesis 4 years after the intervention due to the developed insufficiency of the aortic valve (calcification and deformation of the non-coronary flap), two patients underwent repeated neocuspidalization of the aortic valve with xenopericardium 2 years later due to stenosis of the aortic valve against the background of pronounced calcification of the neocorticules. Freedom from surgery for 7 years was 87%.
Conclusion. The operation of neocuspidalization of the aortic valve according to the Ozaki technique showed good immediate and long- term results in the pediatric patient population, effectively allows postponing prosthetics of the aortic valve with a mechanical prosthesis for a later age period. Further monitoring is required to assess long-term results.
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About the authors
- Vladlen V. Bazylev, Dr. Med. Sci., Professor, Cardiovascular Surgeon, Chief Physician; ORCID
- Aleksey A. Shikhranov, Cand. Med Sci., Cardiovascular Surgeon, Head of Cardiac Surgery Department No. 4 (Children's); ORCID
- Dmitriy A. Bofanov, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
- Ekaterina V. Vostokova, Pediatric Cardiologist; ORCID
- Klara T. Shcheglova, Anesthesiologist-Resuscitator; ORCID
- Dmitriy S. Dudin, Radiologist; ORCID
- Irina S. Nazarova, Pediatric Cardiologist; ORCID
- Tatyana V. Rybakova, Pediatric Cardiologist; ORCID
- Anastasiya O. Ryabova, Pediatric Cardiologist; ORCID
