Midterm Outcomes after Aortic Valve Neocuspidization (Ozaki procedure) in Adults

BACKGROUND:Trileaflet aortic valve neocuspidization (AVN) using autologous pericardium (Ozaki procedure) is an emerging surgical treatment option for aortic valve diseases. While excellent results have been reported from Japan, data pertaining to its use in the U.S. are sparse. METHODS:All adult patients who underwent AVN (AVN group) or SAVR with bioprosthetic valve (SAVR group) were identified between 2015 and 2022. Propensity score matching was used to adjust the baseline characteristics between the two groups. RESULTS:A total of 101 patients underwent AVN, and 1,816 patients underwent SAVR with a bioprosthetic valve. None in the AVN group required conversion to SAVR. Before matching, mean age in the AVN group was 68.5 ± 8.8 years, and 56 (55.4%) patients underwent concomitant procedures. Preoperatively, 3 (3%) had endocarditis. Bicuspid valve was observed in 38 (38.4%). None died at 30 days in the AVN group. The median follow-up duration was 3.2 years. After PSM, the expected survival and freedom from at least moderate aortic regurgitation at 5 years was 91.7 ± 3.1% and 97.6 ± 1.7%, respectively. Propensity score matching yielded 77 patients in each group. The Kaplan-Meier curve demonstrated equivalent survival at 5 years between the two groups (P = .95). Additionally, freedom from at least moderate aortic regurgitation was comparable at 5 years (P = .23). CONCLUSIONS:AVN can be safely performed for a variety of aortic valve diseases with or without concomitant operations. AVN demonstrated similar mid-term outcomes in comparison to SAVR with bioprosthetic valve in the U.S. adult population.