Aortic Valve Reconstruction Surgery Using Autologous Pericardium: The Experience in Vietnam

Abstract

Objective: The study aimed to evaluate the indications and describe the aortic valve reconstruction techniques by Ozaki’s procedure in Vietnam and report mid-term outcomes of this technique in Vietnam. Methods: Between June 2017 and December 2019, 72 patients diagnosed with isolated aortic valve disease, with a mean age of 52.9 (19 – 79 years old), and a male:female ratio of 3:1 underwent aortic valve reconstruction surgery by Ozaki’s technique at Cardiovascular Center, E Hospital, Vietnam. Results: The aortic valve diseases consisted of aortic stenosis (42%), aortic regurgitation (28%), and a combination of both (30%). In addition, the proportion of aortic valves with bicuspid morphology and small annulus (≤ 21 mm) was 28% and 38.9%, respectively. The mean aortic cross-clamp time was 106 ± 13.8 minutes, mean cardiopulmonary bypass time was 136.7 ± 18.5 minutes, and 2.8% of all patients required conversion to prosthetic valve replacement surgery. The mean follow-up time was 26.4 months (12- 42 months), the survival rate was 95.8%, the reoperation rate was 2.8%, and rate of postoperative moderate or higher aortic valve regurgitation was 4.2%. Postoperative valvular hemodynamics was favorable, with a peak pressure gradient of 16.1 mmHg and an effective orifice area index of 2.3 cm . Conclusions: This procedure was safe and effective, with favorable valvular hemodynamics and a low rate of valvular degeneration. However, more long-term follow-up data are needed.

Aortic valve neocuspidization using autologous pericardium compared to surgical aortic valve replacement

“…AVNeo, but did not directly compare them to bioprosthetic valve replacement. [11][12][13]15,20 Pirola et al observed MPG's of 7.5 mmHg ± 3.9 at 3 months after AVNeo 17 and Ngo et al reported on MPG's of 6.8 ± 1.4 mmHg at 1 week after AVNeo. 21 For the Trifecta bioprosthesis, similar results have been reported.…”

“…They showed peak pressure gradients with an average of 19.5 mmHg ± 10.3 1 week after surgery that remained stable up to 8 years 13 . Former research found also encouraging results 14,15 . Krane et al found overall freedom from reoperation of 96.1% after 2 years in 103 patients, 16 and Pirola et al found freedom from major adverse valve‐related events of 97% in 71 patients over 6 years period 17 .…”

“…13 Former research found also encouraging results. 14,15 Krane et al found overall freedom from reoperation of 96.1% after 2 years in 103 patients, 16 and Pirola et al…”

“…17 Recently, Ngo et al reported a reoperation rate of 2.8% over a 26.4-month follow-up period. 15 Nevertheless, studies that compare AVNeo with surgical aortic valve prostheses are lacking. The current study concentrates on the early hemodynamic outcome of patients who received AVNeo or SAVR using the St. Jude Medical Trifecta Aortic bioprosthesis (Trifecta).…”

“Close but no cigar”: Successful aortic valve repair using autologous pericardium

“…There have been reports of its successful use in Brazil, Russia, and Vietnam, [6][7][8][9] for instance, where the population has been relatively younger. In this issue of Journal of Cardiac Surgery, Ngo et al 10 from Vietnam, presents their experience with Ozaki procedure in 72 patients with a mean age of 53 years and mean follow-up of 26 months. Two patients required conversion to prosthetic valve replacement due to coronary obstruction with reconstructed leaflets.…”