Turkish Journal of Thoracic and Cardiovascular Surgery 2019;27(4):454
http://dx.doi.org/doi: 10.5606/tgkdc.dergisi.2019.01904

Editorial Comment / Editoryal Yorum

Ozaki Procedure: 1,100 patients with up to 12 years of follow-up
Ozaki prosedürü: 12 yıla varan takipte 1100 hasta
Shigeyuki OzakiDepartment of Cardiovascular Surgery, Toho University, Ohashi Medical Center, Tokyo, Japan

Ozaki procedure or aortic valve neo-cuspidization
basically includes replacement of aortic valve cusps by
three native autologous pericardial cusps. Its midterm
outcomes have been published previously.[1] This video
article presents the operative technique in a stepwise
method.[2]In our clinic, this operation was performed during
12 years from April 2007 to March 2019, and morethan 1,100 patients were operated. The mean age ofthe patients was 67.7±14.9 years. The etiology wasaortic stenosis in 61.7%, aortic insufficiency in 31.1%,and both in 7.2% of the patients. The mean aortic
cross-clamp and cardiopulmonary bypass times were106.1±30.3 and 151.3±36.9, respectively. The overall
survival rate is 84.6% and freedom from reoperation is
95.8% at 12 years.
This technique can be applied in patients with aortic stenosis, aortic regurgitation, infective endocarditis, and prosthetic valve endocarditis and those with
non-tricuspid aortic valve with a similar method. The
main strengths of the technique are the immediate
superb hemodynamics after the operation and no anticoagulation requirement postoperatively. Regarding
to the operative technique, there may be some additional points to be considered:1.

During the sizing of the cusps, the larger one
should be selected, if one small or larger one
does not exactly fit the sizer.

2. A bovine pericardium can also be used inselected patients, if native pericardium is notavailable. No calcification issue was experienced in our series.
3. A learning period usually includes the first
20 patients for such operation; therefore, theset up and technique should be supervised in
the beginning.
4. If the difference between the sizing of eachcusps is more than 2 mm, a new commissure
should be created to prevent misalignment
between the cusps.
Declaration of conflicting interests
The authors declared no conflicts of interest with respect tothe authorship and/or publication of this article.
Funding
The authors received no financial support for the research
and/or authorship of this article.

REFERENCES
1. Ozaki S, Kawase I, Yamashita H, Uchida S, Takatoh M,Kiyohara N. Midterm outcomes after aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium. J Thorac Cardiovasc Surg 2018;155:2379-2387.
2. Alhan C. Ozaki Procedure. Turk Gogus Kalp Dama
2019;27:451-3.

Received: September 27, 2019 Accepted: September 27, 2019 Published online: October 23, 2019
Correspondence: Shigeyuki Ozaki, MD. Department of Cardiovascular Surgery, Toho University, Ohashi Medical Center, 153-8515 Tokyo, Japan.
e-mail: ozakis@topaz.ocn.ne.jp
Cite this article as:Ozaki S. Ozaki Procedure: 1,100 patients with up to 12 years of follow-up. Turk Gogus Kalp Dama 2019;27(4):454©2019 All right reserved by the Turkish Society of Cardiovascular Surgery.

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