Commentary: Ozaki valve reconstruction in children: Is it still a valve replacement?

Abstract

AVRec, especially in the absence of long-term data. A wellexecuted Ross procedure would be much more indicated here. Other settings in which a Ross or Ross-Konno procedure seems to be better suited would be the subsets of cases in which additional aortic annular enlargement (n ¼ 8) or aortic sinus enlargement (n ¼ 20) was required. The added geometric complexity will make the procedure less reproducible, and my guess is less reliable, in the long term.In conclusion, this is an important spearhead series. Busy, high-volume centers should perform it, refine it, and report on it. Until we see midterm results at least, however, one cannot advocate for the wide generalization of the AVRec in pediatric cardiac surgery. References

Symmetric tricuspidization of a regurgitant quadricuspid truncal valve: A versatile adaptation for aortic valve repair

“…As is the case with the Ozaki procedure in the growing child, the durability of our technique is unknown and may be potentially limited by patient growth and biologic tissue degeneration. 5 Although future interventions will most certainly be required, we believe that oversizing the pericardial leaflet to create a large area of coaptation will delay reoperation and position patients well for repeat valve surgery within the native aortic root.…”

The Year in Review: Anesthesia for Congenital Heart Disease 2021

“…There has not yet been sufficient follow up in children to endorse this procedure over a Ross or mechanical valve replacement. 23 Ross Procedure There has been a resurgence of enthusiasm for the Ross procedure based on multiple reports of excellent short-and long-term results. 13,24,25 Major concerns include the high surgical complexity and risk of degeneration of the aortic autograft and the pulmonic homograft.…”

“…There has not yet been sufficient follow up in children to endorse this procedure over a Ross or mechanical valve replacement. 23…”

Roadmap for Ross procedure: Staged strategy

“…Replacement of only the diseased cusp and preservation of more native tissue may be a more physiologic solution for a growing child with no untoward impact on future replacement options. 19 Regardless of approach, material limitations will inevitably dictate outcome.…”