Innovative combined Ozaki and Bentall procedures for aortic root replacement

In treating aortic root diseases, the Bentall procedure offers reliable and stable results. However, it requires a prosthetic valved conduit, which presents inherent challenges due to the need for anticoagulation. The Ozaki procedure, which uses pericardium for aortic valve neocuspidization, is an alternative to prosthetic valves and does not need anticoagulation. We developed a surgical technique combining the Bentall and Ozaki procedures to treat patients with aortic root disease, which we describe in this article. Because the risk of bleeding due to anticoagulation after prosthetic valve replacement was a concern, we combined the Bentall and Ozaki procedures with a graft conduit using bovine pericardial patch neocuspidization. Postoperative echocardiography showed a competent aortic valve with no regurgitation. We believe that this novel procedure provides hope for a more adaptable and patient-friendly option.