Key result
Aortic valve neocuspidisation adoption prompts expanded patient selection as surgical experience grows.
Why the study?
Little is known about how innovative surgical procedures are modified, the knowledge gained, and decision-making processes during their introduction into clinical practice.
Qualitative research highlights the dynamic nature of surgical innovation, showing how growing experience leads to technique modifications and wider patient selection during the introduction of the Ozaki procedure.
Introduction Innovative surgical procedures undergo modification as they are introduced into clinical practice. Robust evaluation as innovations evolve is crucial to understand safety and efficacy. Little is known, however, about what happens in practice; how/why procedures are modified, the knowledge that is gained or the decision-making processes to continue, adapt or abandon the innovation. This study followed surgical innovation within National Health Service practice. Here, we report on the introduction of aortic valve neocuspidisation with autologous pericardium. Research design and methods A qualitative study using semistructured longitudinal interviews. Surgeons’ views on the innovative procedure, experiences and reflections over time were explored. Setting and participants Longitudinal interviews were conducted with multiple surgeons performing an innovative procedure in one UK teaching hospital. Results 19 interviews with five different surgeons (range: 1–7 interviews per surgeon) were conducted. Identified broad themes were: (1) Ozaki as an innovative and promising alternative treatment, (2) confidence in a well-defined procedure and (3) emerging uncertainties. Interviews elicited surgeons’ strong belief in the procedure as the key driver for its introduction into practice. Growing confidence as surgeons gained experience led to wider patient selection. Despite initial perceptions of a relatively standardised procedure, several modifications were described. Reasons were categorised as anatomical, learning from experience and ambition/strive for perfection. Conclusion This study demonstrates the value of qualitative research in understanding the complexities and decision-making surrounding the introduction and evolution of an innovative surgical procedure as it is introduced into clinical practice. Findings highlight the dynamic nature of innovation and the rationale for modifications to technique and patient selection. Practical tools to support surgical innovators and researchers are needed to ensure robust, transparent and timely early-phase evaluation of procedures/devices.
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Macefield et al. (2026) studied Aortic valve disease (n=5). Aortic valve neocuspidisation with autologous pericardium was evaluated on Surgeons' views on the innovative procedure, experiences and reflections over time. Aortic valve neocuspidisation was evaluated through 19 interviews with 5 surgeons, revealing that growing confidence led to wider patient selection and technique modifications.
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