Key result
Ozaki neocuspidization linked to ~2-fold larger effective orifice area than mechanical valves.
Why the study?
Modern bicuspid aortic valve (BAV) reconstructive surgery has significant limitations, and up to 50% of BAV patients have associated ascending aortopathy. Autologous pericardium neocuspidization (Ozaki technique) is considered an alternative approach, motivating a comparison of its immediate outcomes against mechanical prosthesis implantation during concomitant ascending aortic replacement.
Does Ozaki neocuspidization combined with ascending aortic replacement improve immediate hemodynamic and clinical outcomes compared to mechanical prosthesis implantation in patients with bicuspid aortic valve and ascending aorta dilatation?
Observational (n=137)
No
Does Ozaki neocuspidization combined with ascending aortic replacement improve immediate hemodynamic and clinical outcomes compared to mechanical prosthesis implantation in patients with bicuspid aortic valve and ascending aorta dilatation?
In patients with bicuspid aortic valve and ascending aorta dilatation undergoing concomitant ascending aortic replacement, the Ozaki neocuspidization technique provides significantly superior immediate postoperative hemodynamic parameters (larger effective orifice area and lower transvalvular gradients) compared to mechanical valve replacement, with comparable in-hospital mortality and complication rates.
Hypothesis-generating for better early hemodynamics with Ozaki in bicuspid aortic valve; leaves open durability and randomized confirmation before practice change.
Introduction. Modern advances in bicuspid aortic valve (BAV) reconstructive surgery, despite their significance, have significant limitations. Neocuspidization using autologous pericardium (Ozaki technique) is considered as an alternative approach to correcting BAV pathology. Up to 50% of patients with BAV have associated aortopathy, which can involve the proximal aorta and mid-portion of the ascending aorta. In this article, we present a comparative analysis of the results of Ozaki neocuspidation and mechanical prosthesis implantation in patients with bicuspid aortic valves and concomitant ascending aortic valve replacement (AVR). Aim: To compare the immediate outcomes of Ozaki neocuspidization and mechanical prosthesis implantation in patients with bicuspid aortic valves and concomitant ascending aortic valve replacement. Material and Methods. The study included 137 patients who underwent surgery at the clinic between January 2017 and January 2025. A retrospective observational comparison of surgical outcomes of two groups was performed: Group 1 – the study group, consisting of 63 patients who underwent neocuspidization using the Ozaki technique combined with ascending aortic replacement; Group 2 – the control group, consisting of 74 participants who underwent AVR with a mechanical prosthesis and ascending aortic replacement. Results. A statistically significant difference was observed based on postoperative ultrasound data: the effective orifice area in Group 1 was 4.7 ± 1.1 versus 2.3 ± 0.4 in Group 2 ( p = 0.04). The mean gradient was 4.5 ± 2.1 in Group 1 and 10.6 ± 2.2 in Group 2 ( p = 0.04). The maximum gradient was 9.5 ± 2.8 and 17.6 ± 2.9 in Groups 1 and 2, respectively ( p = 0.04). In-hospital mortality and the incidence of postoperative complications did not differ significantly between the two groups. Conclusion. No statistically significant differences were observed in in-hospital comparisons of intraoperative characteristics and early postoperative complications. However, significantly better hemodynamic parameters were observed in the study group.
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Базылев et al. (2026) conducted an observational in Bicuspid aortic valve and ascending aorta dilatation (n=137). Ozaki neocuspidization combined with ascending aortic replacement vs. Mechanical prosthesis aortic valve replacement combined with ascending aortic replacement was evaluated on Effective orifice area (postoperative ultrasound) (p=0.04). Ozaki neocuspidization yielded a larger effective orifice area (4.7 vs 2.3, p=0.04) and lower mean gradient (4.5 vs 10.6, p=0.04) than mechanical prostheses with similar in-hospital mortality.
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