Aortic valve Surgery: Types of Repair and Reconstruction

Aortic valve surgery is one of the commonly performed procedures in cardiac surgery across the world. As an alternative to the standard approach of replacement of the aortic valve with the prosthesis, either mechanical of bioprosthetic, interest in aortic valve repair has been there for over 20 years.

There are different kinds of repair for the aortic valve, most being for cases with leaking valves. Very few kinds of repair have been used for valve narrowing or stenosis. A large number of repairs utilized the patient’s own pericardium.

However, the rate of reoperation has been high, making this type of repair less than satisfactory. Its limited durability can be explained by imperfect preparation of the pericardium, the design of the pericardial cusps, and the technical performance of the operation. At the same time, commercially available tissue valves are also imperfect with limited durability and imperfect hemodynamics. The limited durability has become the major issue in younger patients and the imperfect hemodynamics has become the major issue in patients with small aortic roots

Recently, a new technique has become popular as one of the aortic valve reconstruction procedures. The procedure is Professor Ozaki’s work in Japan on an aortic cusp replacement technique using pericardial tissue. The procedure published in the prestigious Journal of Thoracic and Cardiovascular Surgery in 2014 shows very impressive outcomes in 404 consecutive patients with only two patients requiring reoperations because of infective endocarditis. The other 402 patients showed less than mild aortic regurgitation, and no thromboembolic events were recorded after a mean follow-up 23.7 +13.1 months. Freedom from reoperation was 96.2% at 53 months of follow-up. These short and medium-term outcome data are as good as or better than those for standard replacement tissue valves regarding all variables, survival, freedom from reoperation, stroke and endocarditis.

1. Halees ZA, Shahid MA, Sanei AA, Sallehuddin A, Duran C. Up to 16 years follow-up of aortic reconstruction with pericardium: a stentless readily available cheap valve? Eur J Cardiothorac Surg. 2005;28:200-5.

2. Chan KMJ, Rahman-Haley S, Mittal TK, Gavino JA, Dreyfus GD. Truly stentless autologous pericardial aortic valve replacement: an alternative to standard aortic valve replacement. J Thorac Cardiovasc Surg. 2011;141:276-83.

3. Shigeyuki Ozaki, Isamu Kawase, Hiromasa Yamashita, Shin Uchida, Yukinari Nozawa, Mikio Takatoh, So Hagiwara. A total of 404 cases of aortic valve reconstruction with glutaraldehyde-treated autologous pericardium. J Thorac Cardiovasc Surg 2014;147:301-6

4. Shigeyuki Ozaki, Isamu Kawase, Hiromasa Yamashita, Shin Uchida, Yukinari Nozawa, Mikio Takatoo, So Hagiwara, Nagaki Kiyohara. Aortic Valve Reconstruction using Autologous Pericardium for Infective Endocarditis with Root Abscess. Toho University, Tokyo, Japan. AATS abstract 2015

5. Shigeyuki Ozaki, Isamu Kawase, Hiromasa Yamashita, Shin Uchida, Yukinari Nozawa, Mikio Takatoh, So Hagiwara and Nagaki Kiyohara. Aortic valve reconstruction using autologous pericardium for ages over 80 years. Asian Cardiovascular & Thoracic Annals 2014;22: 903–908

6. Hiromasa Yamashita, Shigeyuki Ozaki, Kiyotaka Iwasaki, Isamu Kawase, Yukinari Nozawa, and Mitsuo Umezu. Tensile Strength of Human Pericardium Treated with Glutaraldehyde. Ann Thorac Cardiovasc Surg 2012; 18: 434–437

7. Shigeyuki Ozaki, Isamu Kawase, Hiromasa Yamashita, Shin Uchida, Yukinari Nozawa, Mikio Takatoh, So Hagiwara, Nagaki Kiyohara. Reconstruction of Bicuspid Aortic Valve With Autologous Pericardium – Usefulness of Tricuspidization. Circ J 2014;78:1144 – 1151

8. Shigeyuki Ozaki, Isamu Kawase, Hiromasa Yamashita, Shin Uchida, Yukinari Nozawa, Takayoshi Matsuyama, Mikio Takatoh, So Hagiwara. Aortic valve reconstruction using self-developed aortic valve plasty system in aortic valve disease. Interactive CardioVascular and Thoracic Surgery 2011;12:550–553 (2011 Published by European
Association for Cardio-Thoracic Surgery Institutional report – Valves)

9. Isamu Kawase, Shigeyuki Ozaki, Hiromasa Yamashita, Shin Uchida, Yukinari Nozawa, Takayoshi Matsuyama, Mikio Takatoh, So Hagiwara. Aortic valve reconstruction with autologous pericardium for dialysis Patients. Interactive CardioVascular and Thoracic Surgery 2013;16:738–742

10. https://www.rbhh-specialistcare.co.uk/

11. https://publicdocuments.sth.nhs.uk/pil3800.pdf

Other Kinds of repair

Dr. Adil Sadiq attended training by Dr. Ozaki at Tokyo, Japan, in OCT 2017, followed by certification

Link of the lecture program is given below

http://www.ikou-commons.com/

Dr Adil Sadiq has been invited to represent India at the Upcoming world webinar conference on Ozaki Aortic valve reconstruction. Nov 2018

A link of the proposed program is given below

http://www.temdec.med.kyushu-u.ac.jp/