Minimally Invasive Ozaki Procedure in Aortic Valve                     Disease

Objective The Ozaki procedure for aortic valve reconstruction was reported in 2014 with low mortality, a highly reproducible rate and a good midterm result. However, the procedure still requires conventional sternotomy to be accomplished. The aim of the study was to start an initial evaluation for the feasibility of the minimally invasive approach in combination with the Ozaki technique. Methods From January 06, 2017, to January 12, 2017, nine patients with severe aortic valve diseases underwent minimally invasive Ozaki procedure through an upper ministernotomy. The pericardium was harvested endoscopically using three trocars in different intercostal spaces. Then, a ministernotomy was performed and the Ozaki procedure was accomplished in a similar manner to the conventional technique. We analyzed the in-hospital mortality and complications of this group. Results The mean age was 47.4 years and 55.6% patients were female. The predominant pathology was chronic rheumatic valve disease (66.7%) and other patients were diagnosed with a bicuspid aortic valve. The mean aortic cross-clamp time was 106.8 minutes, the mean cardiopulmonary bypass time was 153.6 minutes, the mean ventilation time was 8.4 hours, and the mean intensive care unit time was 1.6 days. No mortality was recorded in our series, no conversion to full sternotomy was required, one patient experienced right hemothorax requiring drainage, and one patient required valve replacement. Intraoperative transesophageal echocardiography and predischarge transthoracic echocardiography showed five competent valves and three valves with trivial regurgitation, and no stenosis was detected. Conclusions Ministernotomy combined with Ozaki procedure might be feasible, as well as an alternative to conventional sternotomy. This approach is associated with low mortality and morbidity and may be beneficial in younger populations.

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Two Alternative Sutureless Strategies for Aortic Valve Replacement

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000007 ◽

2013 ◽

Vol 8 (4) ◽

pp. 253-257 ◽

Cited By ~ 2

Author(s):

Giovanni Concistrè ◽

Giuseppe Santarpino ◽

Steffen Pfeiffer ◽

Pierandrea Farneti ◽

Antonio Miceli ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

New Technology ◽

Paravalvular Leak ◽

Aortic Cross Clamp Time ◽

Invasive Approach ◽

The Mean

Objective Important comorbid conditions in patients referred for aortic valve replacement (AVR) require less invasive strategies. We describe our initial experience with the Perceval S (Sorin Group, Saluggia, Italy) and 3f Enable (Medtronic, Minneapolis, MN USA) sutureless aortic bioprostheses. Methods We compared intraoperative data, postoperative clinical outcomes, and echocardiographic results from patients receiving a Perceval S ( P group; n = 97) or a 3f Enable (E group; n = 32) prosthesis in two cardiac surgery departments (Nuremberg, Germany, and Massa, Italy). Results Baseline patient characteristics were similar in both groups, except for mean ± SD body surface area ( P group = 2.01 ± 2.9 m2, E group = 1.83 ± 3.8 m2; P < 0.001). Sixty-five patients (67%) in the P group and 19 patients (59.5%) in the E group ( P = 0.22) underwent minimally invasive AVR with either ministernotomy or right anterior minithoracotomy approach. Concomitant procedures were performed in 37 patients (38%) in the P group and 9 patients (28%) in the E group ( P = 0.56). In-hospital mortality was 2%. The mean ± SD prosthesis diameter was 23.5 ± 1.4 mm ( P group) compared with 22.1 ± 2 mm (E group) ( P < 0.001). In isolated AVR, aortic cross-clamp time was 36 ± 12.7 minutes in the P group and 66 ± 18 minutes in the E group ( P < 0.001). At a mean ± SD follow-up of 8.3 ± 4.5 months, survival was 97% (one death in the P group). In five patients ( P group = 1, E group = 4), a moderate paravalvular leak was present ( P = 0.013). The mean ± SD transvalvular gradient was 9.1 ± 3.3 mm Hg with the Perceval S and 11.2 ± 5.2 mm Hg with the 3f Enable ( P = 0.017). Conclusions Aortic valve replacement with sutureless aortic bioprosthesis is feasible, also with a minimally invasive approach. The Perceval S showed lower operative times and moderate paravalvular leaks and lower mean transvalvular gradients than did the 3f Enable, related to the larger diameter of the Perceval S implanted. Both prostheses showed an excellent hemodynamic performance. This new technology needs long-term follow-up.

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Sutureless Aortic Valve Implantation through an Upper V-Type Ministernotomy: An Innovative Approach in High-Risk Patients

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e31828d6b03 ◽

2013 ◽

Vol 8 (1) ◽

pp. 23-28 ◽

Cited By ~ 8

Author(s):

Giovanni Concistrè ◽

Antonio Miceli ◽

Francesca Chiaramonti ◽

Pierandrea Farneti ◽

Stefano Bevilacqua ◽

...

Keyword(s):

High Risk ◽

Aortic Valve ◽

Minimally Invasive ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

High Risk Patients ◽

Risk Patients ◽

The Mean ◽

Valve Implantation

Objective Aortic valve replacement in minimally invasive approach has shown to improve clinical outcomes even with a prolonged cardiopulmonary bypass and aortic cross-clamp (ACC) time. Sutureless aortic valve implantation may ideally shorten operative time. We describe our initial experience with the sutureless 3f Enable (Medtronic, Inc, ATS Medical, Minneapolis, MN USA) aortic bioprosthesis implanted in minimally invasive approach in high-risk patients. Methods Between May 2010 and May 2011, thirteen patients with severe aortic stenosis underwent aortic valve replacement with the 3f Enable bioprosthesis through an upper V-type ministernotomy interrupted at the second intercostal space. The mean ± SD age was 77 ± 3.9 years (range, 72–83 years), 10 patients were women, and the mean ± SD logistic EuroSCORE was 15% ± 13.5%. Echocardiography was performed preoperatively, at postoperative day 1, at discharge, and at follow-up. Clinical data, adverse events, and patient outcomes were recorded retrospectively. The median follow-up time was 4 months (interquartile range, 2–10 months). Results Most of the implanted valves were 21 mm in diameter (19–25 mm). The CPB and ACC times were 100.2 ± 25.3 and 66.4 ± 18.6 minutes. At short-term follow-up, the mean ± SD pressure gradient was 14 ± 4.9 mm Hg; one patient showed trivial paravalvular leakage. No patients died during hospital stay or at follow-up. Conclusions The 3f Enable sutureless bioprosthesis implanted in minimally invasive approach through an upper V-type ministernotomy is a feasible, safe, and reproducible procedure. Hemodynamic and clinical data are promising. This innovative approach might be considered as an alternative in high-risk patients. Reduction of CPB and ACC time is possible with increasing of experience and sutureless evolution of actual technology.

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AORTIC VALVE RECONSTRUCTION SURGERY USING AUTOLOGOUS PERICARDIUM: THE EXPERIENCE IN VIETNAM

10.22541/au.163458031.15731882/v1 ◽

2021 ◽

Author(s):

Thanh Hung Ngo ◽

Cong Huu Nguyen ◽

Duc Thinh Do ◽

Hoang Long Luong ◽

Thao Nguyen Phan ◽

...

Keyword(s):

Aortic Valve ◽

Reoperation Rate ◽

Effective Orifice Area ◽

Aortic Cross Clamp Time ◽

Area Index ◽

Reconstruction Surgery ◽

Replacement Surgery ◽

Valve Reconstruction ◽

The Mean

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.

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Minimally invasive Ozaki procedure for aortic valve disease, preliminary results

Perm Medical Journal ◽

10.17816/pmj381100-107 ◽

2021 ◽

Vol 38 (1) ◽

pp. 100-107

Author(s):

B. K. Kadyraliev ◽

V. B. Arutyunyan ◽

V. A. Chragyan ◽

Magamedganipa N. Askadinov ◽

Soslan T. Enginoev ◽

...

Keyword(s):

Aortic Valve ◽

Minimally Invasive ◽

Cardiovascular Surgery ◽

Mean Value ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Valve Reconstruction ◽

Valve Diseases ◽

Mean Time ◽

Federal Center

Objective. To assess the efficiency and realizability of the surgical technique of aortic valve reconstruction using autologous pericardium treated by glutaraldehyde in different aortic valve diseases such as aortic stenosis, aortic regurgitation, rheumatic and degenerative diseases of aortic valve. In 2014, Ozaki presented the technique described. Materials and methods. In this work we analysed 10 cases of ministernomy combined with Ozaki procedure in patients operated at Sukhanov Federal Center for Cardiovascular Surgery. Results. No hospital mortality was registered in our study. Intraoperatively, transition to a full sternotomy was not required. A mean time of aortic cross-clamping was 84.6 ( 14.4) minutes, a mean value of artificial circulation was 103.1 ( 17.7) minutes, a mean time of ventilation was 8.4 hours, and a mean time of staying in intensive care unit room was 1.6 days. Conclusions. Minimally invasive approach combined with Ozaki procedure is realizable; it is an alternative to conventional sternotomy and should be used for patients in grave condition having concomitant diseases.

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Minimally Invasive Transaortic Repair of the Mitral Valve

The Heart Surgery Forum ◽

10.1532/hsf98.20101133 ◽

2011 ◽

Vol 14 (4) ◽

pp. 232 ◽

Cited By ~ 2

Author(s):

Orlando Santana ◽

Joseph Lamelas

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Operative Mortality ◽

The Mean ◽

Transaortic Approach

Objective: We retrospectively evaluated the results of an edge-to-edge repair (Alfieri stitch) of the mitral valve performed via a transaortic approach in patients who were undergoing minimally invasive aortic valve replacement.Methods: From January 2010 to September 2010, 6 patients underwent minimally invasive edge-to-edge repair of the mitral valve via a transaortic approach with concomitant aortic valve replacement. The patients were considered to be candidates for this procedure if they were deemed by the surgeon to be high-risk for a double valve procedure and if on preoperative transesophageal echocardiogram the mitral regurgitation jet originated from the middle portion (A2/P2 segments) of the mitral valve.Results: There was no operative mortality. Mean cardiopulmonary bypass time was 137 minutes, and mean cross-clamp time was 111 minutes. There was a significant improvement in the mean mitral regurgitation grade, with a mean of 3.8 preoperatively and 0.8 postoperatively. The ejection fraction remained stable, with mean preoperative and postoperative ejection fractions of 43.3% and 47.5%, respectively. Follow-up transthoracic echocardiograms obtained at a mean of 33 days postoperatively (range, 8-108 days) showed no significant worsening of mitral regurgitation.Conclusion: Transaortic repair of the mitral valve is feasible in patients undergoing minimally invasive aortic valve replacement.

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P24: MANAGEMENT OF RHEUMATIC VALVE DISEASE OF THE AORTIC VALVE USING THE OZAKI PROCEDURE WITH AUTOLOGOUS PERICARDIUM

British Journal of Surgery ◽

10.1093/bjs/znab117.109 ◽

2021 ◽

Vol 108 (Supplement_1) ◽

Author(s):

A Asif ◽

M Caputo

Keyword(s):

Aortic Valve ◽

Intraoperative Complications ◽

Valve Disease ◽

Severe Aortic Regurgitation ◽

Autologous Pericardium ◽

End Diastolic Volume ◽

Rheumatic Valve Disease ◽

Coronary Cusp ◽

Valve Pathology ◽

Diastolic Murmur

Abstract Case-Study A 15-year-old boy was referred to our tertiary centre from his local paediatric services with a background of rheumatic fever, severe aortic regurgitation (AR) and mild to moderate mitral regurgitation. He had a history of angina and dyspnoea on exertion, a 2/6 ejection systolic murmur and 2/4 end diastolic murmur. Transthoracic echocardiography showed severe aortic valve insufficiency (with flow reversal seen in the descending aorta and an LV end diastolic volume of 173 ml/m2) and trivial pulmonary valve regurgitation. Autograft failure following the favoured Ross procedure deemed the patient as a candidate for an Ozaki procedure. Autologous pericardium was used to replace the diseased aortic valve. Intraoperative transoesophageal echocardiography showed a deficient left coronary cusp leaflet and a retracted right coronary cusp leaflet. The patient was under cardiopulmonary bypass for 124 minutes and on cross-clamping for 99 minutes with no intraoperative complications. Histological examination of the aortic valve leaflets showed neovascularisation, myxoid changes and disarray of the fibrous stroma. Postoperative recovery was uneventful. The postoperative echocardiogram showed trivial AR, end diastolic volume 217ml, end systolic volume 12 ml and 40% ejection fraction. There was full resolution of the dyspnoea, angina and diastolic murmur on follow-up 4-months postoperatively as supported by healthy valve function on echocardiography. This case highlights that in those of risk of multiple valve pathology, such as in rheumatic valve disease, an Ozaki procedure using autologous pericardium is a viable surgical option for paediatric aortic valve repair with good outcomes. Take-home message In cases of systemic conditions affecting the heart valves where there is multiple valve pathology and risk of autograft failure, such as rheumatic valve disease, the use of autologous pericardium to replace these valves has shown to be a viable option in this paediatric case.

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Endoscopy-Assisted Achilles Tendon Reconstruction With a Central Turndown Flap and Semitendinosus Augmentation

Foot & Ankle International ◽

10.1177/1071100716666365 ◽

2016 ◽

Vol 37 (12) ◽

pp. 1333-1342 ◽

Cited By ~ 4

Author(s):

Prashant N. Gedam ◽

Faizaan M. Rushnaiwala

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Achilles Tendon Rupture ◽

Wound Complication ◽

Reconstruction Technique ◽

Level Of Evidence ◽

Invasive Approach ◽

Perioperative Morbidity ◽

The Mean

Background: The objective of this study was to report the results of a new minimally invasive Achilles reconstruction technique and to assess the perioperative morbidity, medium- to long-term outcomes, and functional results. Methods: Our series was comprised 14 patients (11 men and 3 women), with a mean age of 45.6 years at surgery. Each patient had a chronic Achilles tendon rupture. The mean interval from rupture to surgery was 5.5 months (range, 2-10). The mean total follow-up was 30.1 months (range, 12-78). All patients were operated with a central turndown flap augmented with free semitendinosus tendon graft and percutaneous sutures in a minimally invasive approach assisted by endoscopy. The patients underwent retrospective assessment by clinical examination, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, and the Achilles Tendon Total Rupture Score (ATRS). Paired t tests were used to assess the preoperative and postoperative AOFAS scores, ATRS scores, and ankle range of motion. Results: The length of the defect ranged from 3 to 8 cm (mean, 5.1), while the length of the turndown flap ranged from 8 to 13 cm (mean, 10.1). The mean AOFAS score improved from 64.5 points preoperatively to 96.9 points at last follow-up. The mean ATRS score improved from 49.4 preoperatively to 91.4 points at last follow-up. None of the patients developed a wound complication. No patient had a rerupture or sural nerve damage. Conclusion: All patients in our study had a favorable outcome with no complications. We believe that with this triple-repair technique, one can achieve a strong and robust repair such as in open surgery while at the same time reducing the incidence of complications. Level of Evidence: Level III, retrospective comparative study.

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Minimally invasive redo aortic valve replacement with a sutureless valve implant

10.1510/mmcts.2021.008 ◽

2021 ◽

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Valve Prosthesis ◽

Mechanical Prosthesis ◽

Invasive Approach ◽

Replacement Procedure ◽

Aortic Valve Prosthesis ◽

Sutureless Valve

Reoperations for a dysfunctional mechanical aortic valve prosthesis are usually performed with a repeat sternotomy. Reopening the chest may be associated with a heart structure tear, bleeding, excessive transfusion, and a possible unfavorable outcome. Experience performing a redo aortic valve replacement with a minimally invasive approach and avoiding lysis of the pericardial adhesions is growing. We describe a redo aortic valve replacement procedure performed because of subvalvular pannus formation in a patient with a mechanical prosthesis. A partial J-shaped hemisternotomy at the 3rd intercostal space was performed; the ascending aorta was exposed and the valve was replaced with a sutureless bioprosthesis. The video tutorial shows the surgical approach, cardiopulmonary bypass solutions, and sutureless valve deployment.

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