Short-term outcomes of aortic valve neocuspidization using autologous fixed pericardium versus aortic valve replacement using mechanical prosthesis in patients with aortic valve disease

doi:10.4103/ejs.ejs_132_23

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Short-term outcomes of aortic valve neocuspidization using autologous fixed pericardium versus aortic valve replacement using mechanical prosthesis in patients with aortic valve disease

Published Jul 1, 2023 · Moustafa Gamal-Eldin El Barbary, Amr Ahmed Seddik, Mohamed Attia Hussein

The Egyptian Journal of Surgery

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Abstract

Background Aortic valve replacement by prosthetic valves, either mechanical or biological, is the ultimate known therapy for patients with aortic valve disease whether stenosis or regurgitation. However, these prostheses may have the concern of valve degeneration and the need for reoperation with the biological valves or the need for lifelong anticoagulation with considerable side effects with the mechanical valves. In this study, we compare the application of the new Ozaki technique in Ain Shams University Hospitals Cardiothoracic Academy to the current practice of aortic valve replacement using mechanical valve prosthesis Aim of the work To study the hemodynamic performance and major adverse events that are related to the valve of the novel technique in reconstructing the aortic valve using autologous pericardium (AVNeo) versus the conventional aortic valve replacement using a prosthetic mechanical valve. Patients and methods This was a nonrandomized clinical trial on 20 patients conducted at Ain Shams University Hospitals Cardiothoracic Academy during the period from November 2021 to December 2022. Inclusion criteria include age from 18 to 65 years, moderate to severe aortic stenosis, and sole aortic valve disease. Exclusion criteria include refusal of the Ozaki technique, concomitant intervention of the aortic arch, emergency surgery, porcelain aorta, and previous cardiac surgery. We divided the patient population into two groups through nonrandom allocation: Group I: aortic valve neocuspidization using autologous fixed pericardium and group II: aortic valve replacement using mechanical prosthesis. Results The hemodynamic performance of patients who underwent aortic valve replacement with either the AVNeo or AVR techniques was evaluated at discharge and 3 months postsurgery. No significant differences were observed in mean and median values of MPG, vena contracta, and coaptation length between the groups at discharge and 3 months postsurgery. However, at 3 months, the mean PPG was significantly lower in the AVNeo group compared with the AVR group (14.80±3.01 vs. 24.00±6.80, P<0.001). In addition, there was a significant decrease in mean PPG and MPG values within the AVNeo group at 3 months compared with at discharge (P=0.005 and P<0.001, respectively), whereas no significant change was observed in the AVR group. These findings suggest that the AVNeo technique may offer better hemodynamic outcomes in terms of PPG compared with the AVR technique at 3 months postsurgery. Conclusion Results showed that both AVNeo and AVR exhibit comparable outcomes at discharge and at 3 months after the study’s conclusion. The postoperative morbidity and mortality are low with the Ozaki procedure, making it dependable and safe.

Study Snapshot

Key takeawayThe AVNeo technique may offer better hemodynamic outcomes in terms of platelet aggregation compared to the AVR technique at 3 months postsurgery.

PopulationOlder adults (50-71 years)

Sample size24

MethodsObservational

OutcomesBody Mass Index projections

ResultsSocial networks mitigate obesity in older groups.

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Paper

Short-term outcomes of aortic valve neocuspidization using autologous fixed pericardium versus aortic valve replacement using mechanical prosthesis in patients with aortic valve disease

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References

Excellent hemodynamic performance after aortic valve neocuspidization (AVNeo) using autologous pericardium.

Aortic valve neocuspidization (AVNeo) using autologous pericardium shows low reoperation rates, excellent hemodynamic performance, and stable pressure gradients within the first year.

Aortic valve construction using pericardial tissue: short-term single-centre outcomes.

Aortic valve construction using pericardial tissue may be an alternative for middle-age patients with aortic valve disease in whom valve repair is not possible.

Midterm outcomes after aortic valve neocuspidization with glutaraldehyde‐treated autologous pericardium

The midterm outcomes of aortic valve neocuspidization using autologous pericardium were satisfactory in 850 patients with various aortic valve diseases.

Aortic valve reconstruction using self-developed aortic valve plasty system in aortic valve disease.

Aortic valve plasty using glutaraldehyde-treated autologous pericardium is a safe and effective treatment for aortic valve disease, with 100% freedom from reoperation at three years follow-up.

Up to 16 years follow-up of aortic valve reconstruction with pericardium: a stentless readily available cheap valve?

Aortic valve reconstruction with pericardium (AoR) is feasible, has good hemodynamics, low mortality, and thromboembolic rate, and is comparable to stentless aortic valve bioprosthesis at 10 years.

Aortic valve replacement with freehand autologous pericardium.

Aortic valve replacement with stentless autologous pericardium shows promising results, with excellent macroscopic and microscopic findings and no thromboembolic events.

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