Impact of Coronary Artery Disease on Long-Term Valve Function After the Ozaki Procedure: A Single-Center Retrospective Cohort Study (2015 - 2020).

INTRODUCTION: The Ozaki procedure reconstructs the aortic valve with autologous pericardium, but long-term leaflet durability remains uncertain. Coronary artery disease (CAD) may reflect a systemic atheroinflammatory milieu associated with impaired leaflet integrity. METHODS: We retrospectively studied 733 patients undergoing Ozaki reconstruction from 2015 to 2020 and assessed the association between CAD and aortic regurgitation (AR) ≥ 2 at last echocardiographic follow-up. Baseline heterogeneity was addressed using propensity-score overlap weighting based on age, sex, body mass index, body surface area, weight, diabetes, European System for Cardiac Operative Risk Evaluation II, aortic stenosis, bicuspid valve, and peripheral artery disease. Effects were estimated as weighted risk ratios (RRs) using Poisson models with robust variance. Sensitivity analyses used stabilized inverse probability of treatment weighting (IPTW) and an extended model including prior myocardial infarction/percutaneous coronary intervention. RESULTS: Of 733 patients, 365 (49.8%) had CAD. Unadjusted AR > 2 rates were 10.1% in CAD vs. 5.7% in no-CAD patients (P = 0.037). After overlap weighting, weighted risks were 12.7% vs. 6.2%, yielding RR 2.05 (95% CI, 1.01 - 4.18; P = 0.048), with excellent covariate balance. IPTW showed consistent results: RR 2.22 (95% CI, 1.38 - 3.56; P = 0.001). Regurgitation-free survival was lower in CAD patients (log-rank P = 0.0087). CONCLUSION: CAD was associated with an approximately two-fold higher risk of AR ≥ 2 after Ozaki reconstruction. This association likely reflects systemic atheroinflammatory processes rather than a direct mechanical effect, supporting closer postoperative surveillance in CAD patients.