Aortic Valve Reconstruction—The Ozaki Technique

The authors present a case involving a 63-year-old male patient with severe aortic stenosis who was treated with aortic valve reconstruction using the Ozaki technique. 

Harvesting of Anterior Pericardium and Fixation in Glutaraldehyde Solution 

At least 7x8 cm of anterior pericardium was harvested, cleaned of fat and other redundant tissues, and then fixed in a 0.6 percent glutaraldehyde solution for 10 minutes. 

Aortic Valve Excision and Annular Decalcification 

The aorta was opened, and the native cusps were excised. The aortic annulus underwent extensive and accurate decalcification. 

Sizing of Neocusps 

Using a dedicated sizer, the distance between each commissure was measured, ensuring that the two horns of the sizer were correctly placed at the commissures. 

Trimming Neocusps From Autologous Pericardium 

New leaflets corresponding to the measured value were trimmed from the glutaraldehyde-treated autologous pericardium employing an original template. Care was taken to leave additional tissue on the two sides of the leaflet. These wings will later serve to reinforce the commissures. 

Suturing Neocusps to the Aortic Annulus 

The neocusps were sutured to the native aortic annulus with a running suture of 4-0 Prolene, starting at the nadir of the annulus. 

A critical aspect of the reconstruction is ensuring correct spacing of the bites. The distances between each bite on the autologous pericardium must be regular and fixed, while the spacing on the aortic annulus varies from the nadir to the commissural zone. 

Closer to the nadir, the distance between bites on the aortic annulus is shorter than the distance on the neocusp, maintaining a 3:1 ratio. As one moves toward the commissure, the discrepancy normalizes, reaching 1:1 correspondence. 

Commissural Wing Fixation 

The wings of the neocusps are then fixed using a U-shaped stitch with 4-0 Prolene with a pledget outside the aorta to improve commissural stability. 

After resuspending the three commissures, a visual check was performed, enhanced with negative pressure made by a left ventricular vent to evaluate the degree of coaptation. 

The postoperative echocardiography revealed no residual regurgitation, with a mean gradient of 5mmHg. 

References

1. Ozaki S, Kawase I, Yamashita H, Uchida S, Nozawa Y, Matsuyama T, Takatoh M, Hagiwara S. Aortic valve reconstruction using self-developed aortic valve plasty system in aortic valve disease. Interact Cardiovasc Thorac Surg. 2011 Apr;12(4):550-3.
2. Ricciardi G, Biondi R, Tamagnini G, Giglio MD. Aortic Valve Reconstruction with Ozaki Technique. Braz J Cardiovasc Surg. 2022 Mar 10;37(1):118-122.

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