Early to Mid-Term Results of Aortic Valve Neocuspidization for Rheumatic Aortic Valve Disease

Sanad and colleagues report promising early- to mid-term outcomes of aortic valve neocuspidization (AVNeo), commonly known as the Ozaki procedure, in patients with rheumatic heart disease.  The study was conducted in Egypt, where rheumatic heart disease remains prevalent. Over a nearly four-year period, 33 patients with rheumatic disease underwent AVNeo, with a mean age of approximately 39 years. Overall survival was excellent, with no early mortalities and only two late deaths: one due to infective endocarditis and aortic root abscess three years postoperatively, and the other from COVID-19 approxiamtely two weeks after surgery. Two patients required early reoperations: one for bleeding and the other for aortic insufficiency due to failure of the right neo-cusp, which the authors attribute to suture line dehiscence. One patient required permanent pacemaker implantation one year after surgery, potentially due to conduction tissue injury during debridement.  Despite the relatively young age of the cohort, AVNeo was favored over other valve replacement options for its potential to reduce the need for future reoperations and to avoid lifelong anticoagulation. The authors also emphasize the cost-effectiveness of AVNeo, particularly highlighting its relevance in low- to middle-income and resource-limited settings.  Overall, this study supports AVNeo as a promising surgical option with favorable early and mid-term outcomes in a challenging patient population.