The Ozaki Procedure: Standardized Protocol Adoption of a Complex Innovative Procedure

Viral Patel, MD; Shinya Unai, MD; Ryan Moore, MD; Habib Layoun, MD; Serge Harb, MD; Michael Z.Y. Tong, MD; Tara Karamlou, MD; Hani K. Najm, MD; Lars G. Svensson, MD, PhD; Jeevanantham Rajeswaran, PhD; Eugene H. Blackstone, MD; Gösta B. Pettersson, MD, PhD

Structural Heart (Jan 2024)

The Ozaki Procedure: Standardized Protocol Adoption of a Complex Innovative Procedure

Viral Patel, MD,
Shinya Unai, MD,
Ryan Moore, MD,
Habib Layoun, MD,
Serge Harb, MD,
Michael Z.Y. Tong, MD,
Tara Karamlou, MD,
Hani K. Najm, MD,
Lars G. Svensson, MD, PhD,
Jeevanantham Rajeswaran, PhD,
Eugene H. Blackstone, MD,
Gösta B. Pettersson, MD, PhD

Affiliations

Viral Patel, MD: Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Shinya Unai, MD: Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Address correspondence to: Shinya Unai, MD, Department of Thoracic and Cardiovascular Surgery Cleveland Clinic, 9500 Euclid Avenue/Desk J4-1, Cleveland, OH 44195.
Ryan Moore, MD: Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Habib Layoun, MD: Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Serge Harb, MD: Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Michael Z.Y. Tong, MD: Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Tara Karamlou, MD: Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Hani K. Najm, MD: Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Lars G. Svensson, MD, PhD: Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
Jeevanantham Rajeswaran, PhD: Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
Eugene H. Blackstone, MD: Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
Gösta B. Pettersson, MD, PhD: Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA

Journal volume & issue: Vol. 8, no. 1
p. 100217

Abstract

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Background: The Ozaki procedure using autologous pericardium is an interesting but complex alternative for aortic valve replacement. We present a standardized approach to minimize the learning curve and confirm reproducibility. Methods: After careful preparation, from May 2015 to February 2021, an Ozaki procedure was performed on 46 patients age 51 ± 14 years. Seven had unicuspid (15%), 29 bicuspid (63%), and 10 tricuspid (22%) aortic valves, and 2 patients had endocarditis. Endpoints were operative learning curves, perioperative outcomes, intermediate-term valve hemodynamics, reintervention, health-related quality of life (MacNew Heart Disease Health-Related Quality of Life questionnaire), and mortality. Results: Cardiopulmonary bypass and aortic clamp times decreased from 145 to 125 minutes and 120 to 100 minutes, respectively, over the first 20 cases, reflecting the learning curve. There was no major perioperative morbidity or mortality. Median postoperative stay was 6.9 days. Aortic regurgitation was mild or less in all but 2 patients who developed moderate aortic regurgitation. Mean aortic valve gradient was 7.9 mmHg postoperatively, 9.2 mmHg by 6 months, and constant thereafter. Left ventricular ejection fraction was 58% preoperatively, 60% at 6 months, and remained stable thereafter. One patient developed infective endocarditis 7 months postoperatively, failed medical management, and underwent valve replacement at 14 months. Two-year survival was 96%, with 1 noncardiac death at 16 months. Health-related quality of life in mental, physical, and emotional domains was better than matched norms, global 6.2 vs. 5.0 (p < 0.0001). Conclusions: Using a well-prepared standardized approach, the Ozaki procedure is reproducible with a short learning curve, excellent hemodynamic performance, and good quality of life.

Published in Structural Heart

ISSN: 2474-8706 (Print); 2474-8714 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.sciencedirect.com/journal/structural-heart

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