Valve Performance and Durability of the Ozaki Procedure Using Bovine Pericardial Tissue

Objectives Using bovine pericardium allows the Ozaki procedure to be performed minimally invasively or in patients with abnormal pericardium, but its comparative effectiveness has not been tested. We compare hemodynamic performance and outcomes of the Ozaki procedure performed with bovine pericardium to (1) the original Ozaki procedure performed with autologous pericardium and (2) aortic valve replacement with a stented bovine pericardial bioprosthesis. Methods From 1/1/2007–5/1/2021, 48 patients underwent the Ozaki procedure with bovine pericardium at Toho University Ohashi Medical Center. Mean aortic valve gradient, aortic regurgitation grade, and freedom from reoperation were compared with those of 43 propensity-matched patients undergoing the Ozaki procedure with autologous pericardium and with 48 propensity-matched patients undergoing valve replacement with a bovine pericardial bioprosthesis at Cleveland Clinic from 1/1/2011–1/1/2022. Results In matched Ozaki patients receiving bovine versus autologous pericardium, mean gradients at 5 years were 11 versus 7.0 mmHg, respectively ( P =.0013), moderate/severe regurgitation was 0.0% versus 2.3%, and freedom from aortic valve reoperation was 100% for both. Comparing matched Ozaki patients receiving bovine pericardium with patients undergoing valve replacement, mean gradients at 5 years were 11 versus 11 mmHg, respectively ( P =.78), moderate/severe regurgitation was 0.0% versus 2.0%, and freedom from reoperation was 100% for both. Conclusions Use of bovine pericardium for the Ozaki procedure demonstrated slightly higher mean gradients compared with autologous pericardium, but outcomes are similar. These findings support continued use of the Ozaki procedure with bovine pericardium, particularly in cases with inadequate native pericardium and for minimally invasive approaches.