A new frontier in aortic valve treatment: surgical & echocardiographic evaluation of the Ozaki procedure

Abstract Background Aortic valve disease (AVD) significantly impacts global health, especially in regions where rheumatic heart disease is prevalent. Traditional aortic valve replacement options have limitations, such as the need for lifelong anticoagulation with mechanical valves and limited durability of bioprosthetic valves. The Ozaki procedure, or aortic valve neo-cuspidization using autologous pericardium, offers a potential alternative. This study evaluates the Ozaki procedure as a novel frontier in aortic valve treatment by assessing its surgical feasibility, echocardiographic outcomes, and its impact on left ventricular remodeling in patients with aortic valve disease. Results Nineteen patients with severe AVD underwent the Ozaki procedure at Mansoura University between October 2021 and February 2022. The mean age was 54.95 ± 11.39 years, and 73.7% were male. Severe aortic stenosis was present in 63.2% of patients. Preoperative mean aortic valve area increased from 1.072 ± 1.000 cm2 to 2.864 ± 0.712 cm2 postoperatively ( p < 0.001). The mean trans-aortic pressure gradient decreased from 57.58 ± 27.94 mmHg to 6.89 ± 2.233 mmHg ( p < 0.001). Left ventricular mass index significantly reduced, indicating favorable cardiac remodeling over a mean follow-up of 14.75 ± 7.44 months. There were no operative mortalities or conversions to traditional valve replacement. One patient (5.3%) required temporary pacemaker insertion. Patients maintained improved valve function and clinical status with a stable aortic valve area (2.66 ± 0.45 cm2) and a low mean trans-aortic pressure gradient (5.33 ± 2 mmHg). Left ventricular mass index significantly decreased from 155.07 ± 39.80 g/m2 to 93.09 ± 27.39 g/m2. Conclusions This technique showed potential for favorable short-term outcomes in aortic valve disease, improving valve function and left ventricular remodeling with low complication rates. It could serve as a viable alternative to conventional aortic valve replacement, particularly for patients with small aortic annuli or those seeking a biological option without long-term anticoagulation.