Subclinical leaflet thrombosis in Ozaki procedure

Aortic valve reconstruction with autologous glutaraldehyde-fixed pericardium (Ozaki procedure) represents an alternative to conventional prosthetic valve replacement, allowing excellent haemodynamic outcomes. We report two cases of subclinical leaflet thrombosis (SLT) at 12 and 23 months of follow-up. Anticoagulation was initiated, and later echocardiography showed haemodynamic and mobility improvement. SLT is well documented for bioprosthetic valve. To our knowledge, this is the first report for Ozaki procedure in an adult population. Glutaraldehyde is known for cytotoxicity, and partial endothelialization can be responsible for thrombosis, creating favourable conditions for later endocarditis and degeneration. Anticoagulation should be recommended postoperatively for the first 3 months with control at 6 months. Finally, alternative treatment to glutaraldehyde should be investigated.