Comparison of early and midterm results in patients with a narrow aortic root after aortic valve replacement using a biological prosthesis with aortic root enlargement and aortic leaflets replacement with autologous pericardium (Ozaki procedure)
Abstract
Purpose:to compare the early and midterm results in patients with a narrow aortic root after aortic valve replacement using a biological prosthesis with aortic root enlargement and aortic leaflets replacement with autologous pericardium (Ozaki procedure).
Material and methods. This prospective, single-center study includes 60 patients with isolated aortic stenosis and a narrow aortic root (fibrous ring diameter less than 20 mm). Patients were divided into two groups. The 1st group consists of 30 patients with a mean age of 67±4.7 years who underwent biological valves implantation and previous posterior enlargement of the aortic annulus using the Nicks–Nunez surgical technic. The 2nd group consists of 30 patients with a mean age of 65±4.8 years who underwent aortic leaflets replacement with autologous pericardium (Ozaki procedure).
Results. The observation period was 18 months. All patients underwent transthoracic and transesophageal echocardiographic examination in the preoperative period, before hospital discharge, in 6 and 18 months after surgery. During the observation period no cases of mortality or prosthesis dysfunction was detected. In the postoperative period, in the 1st group of patients (with an implanted biological valve), 1 (3%) patients with severe, 11 (36%) patients with moderate and 8 patients with a mild prosthesis – patient mismatch were identified. In the 2nd group (Ozaki procedure), no prosthesis – patient mismatch were identified. Significant differences were found in the values of aortic valve area (AVA) and the indexed value of aortic valve area (1.69±0.18cm2 vs 2.67± 0.72 cm2, p<0.001; 0.9±0.16 cm2/m2 vs 1.49±0.42 cm2/m2, p<0.001). Hemodynamic parameters of the maximum (Gmax) and medium (Gmean) transaortic gradient, aortic valve opening time in the early postoperative period in patients of the 2nd group are significantly differ than in patients of the 1st group, Gmax in the 1st group was 38.2±10.0 mm Hg, in the 2nd group – 12.4±5.5 mm Hg,p<0.001; Gmean index in the 1st group – 20.3±5.3 mm Hg, in the 2nd group – 6.1±2.7 mm Hg, p<0.001; acceleration time (AT) indicator in the 1st group – 79±7 ms, in the 2nd group – 61±9 ms, p<0.001. Faster regression of left ventricular hypertrophy (LV) was noted (LV mass index in the 1st group was 136 ±25 g/m2, in the 2nd group –120±19 g/m2, p=0.02), the best tolerance to physical exertion (6-minute walk test in group 1334±40 m, in group 2400±46, p<0.001) and faster recovery of LV systolic function (indicators of global longitudinal strain in 1st group 14,3±3%, in the 2nd group – 17.2±2, p=0.03). Regression of left ventricular hypertrophy was detected in both groups (the left ventricular myocardium mass index in the 1st group was 136±25 g/m2, in the 2nd group –120±19 g/m2,p=0.02). 6-minutes walk test in the 1st group – 334±40 m, in the 2nd group – 400±46, p<0.001. Indicators of global longitudinal strain in the 1st group – 14.3±3%, in the 2nd group –17.2±2, p=0.03.
Conclusion. Aortic leaflets replacement with autologous pericardium (Ozaki procedure) in patients with severe aortic root stenosis shows the better echocardiographic and clinical outcomes in the early and midterm period of observation.
Keywords:prosthesis-patient mismatch, Ozaki procedure, enlargement of the aortic annulus using the Nicks– Nunez technic
For citation: Bazylev V.V., Rosseykin E.V., Babukov R.M., Mikulyak A.I., Bartosh F.L., Slastin Ya.S. Comparison of early and midterm results in patients with a narrow aortic root after aortic valve replacement using a biological prosthesis with aortic root enlargement and aortic leaflets replacement with autologous pericardium (Ozaki procedure). Clin Experiment Surg. Petrovsky J. 2019; 7 (1): 34–43. doi: 10.24411/2308-1198-2019-11005. (in Russian)
Received 25.06.2018. Accepted 06.02.2019.
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