Aortic Valve Reinterventions after Ozaki: Clinical Case Series from Four Centers

Introduction. One of surgical methods for treatment of aortic valve (AV) pathology is Aortic Valve Neocuspidalization Ozaki procedure (AVNeo). Thus, according to the latest systematic review, freedom from reoperation within one, three, five years after AVNeo was 98%, 97% and 96%. Available references provide few descriptions of reoperations after AVNeo. Aim. To analyze the immediate results of AV reinterventions after AVNeo. Materials and methods. In the medium term, reinterventions after AVNeo were necessary for 11 patients (4.3%). The age of patients ranged from 26 to 69 years. 11 patients who underwent surgery included 6 males and 5 females. Four patients had class III-IV CHF, according to NYHA classification. Three patients had previously been operated on for infective endocarditis (IE), and five patients had bicuspid aortic valve. The duration of follow-up, from AVNeo surgery to reinterventions, ranged from 3 to 43 months. Results and discussion. All patients underwent an isolated AV intervention. The main causes of dysfunction were IE (six patients) and leaflet rupture in the commissural area (five patients). Seven patients underwent aortic valve replacement with mechanical valves, one patient — with aortic homograft valve, one patient — with tissue valve and two patients underwent valve repair. In the early postoperative period, one patient had bleeding with the development of cardiac tamponade and one patient had a haemorrhagic stroke. No patients had ARF, perioperative myocardial damage, sternal infection or permanent pacemaker implantation. Two patients died during the hospital period. Conclusions. AV reinterventions are associated with a high incidence of complications and deaths. Therefore, prevention of IE and commissure enhancement should reduce the frequency of repeated interventions, which is to be confirmed by prospective studies in large cohorts of patients.