Application of Ozaki operation in treatment of aortic regurgitation in children_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Xinrong , ZHU Hongbin , DONG Wei , HU Renjie , SUN Yanjuan ,  ZHANG Haibo

Department of Pediatric Cardiovascular Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, P.R.China;

Corresponding author：

ZHANG Haibo, Email: zhanghaibo@scmc.com.cn

Keywords：

Congenital heart disease; aortic regurgitation; Ozaki operation; treatment

DOI：

10.7507/1007-4848.202001067

Video：

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Objective To explore the early results of Ozaki operation in children with aortic regurgitation.Methods We retrospectively analyzed the clinical data of 15 patients with aortic regurgitation who received the Ozaki operation in our hospital from April 2017 to July 2019. There were 11 males and 4 females with an average operation age of 10.7±3.7 years. Besides preoperative evaluation, aortic regurgitation and cardiac function were evaluated on 1 day, 1 week, 1 month, 3 months, and 6-12 months after surgery.Results In 14 (93.3%) patients , the aortic valve leaflets functioned well on 1 day, 1 month, 3 months, and 6-12 months, and the regurgitation grade was Ⅰ-Ⅱ, which was improved than before (P=0.001). The cardiac function of children recovered quickly after operation. There was no statistical difference in ejection fraction on 1 day, 1 month, 3 months, and 6-12 months after operation (P>0.05). No children died, and no other clinical event was found.Conclusion The Ozaki technique of reconstructing a tricuspid aortic valve leaflet for the treatment of severe aortic regurgitation in children is effective in short term, and the persistence of its valve function remains to be determined in the long-term follow-up.

Citation： LIU Xinrong, ZHU Hongbin, DONG Wei, HU Renjie, SUN Yanjuan, ZHANG Haibo. Application of Ozaki operation in treatment of aortic regurgitation in children. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(11): 1292-1297. doi: 10.7507/1007-4848.202001067 Copy

1.	Vergnat M, Asfour B, Arenz C, et al. Contemporary results of aortic valve repair for congenital disease: lessons for management and staged strategy. Eur J Cardiothorac Surg, 2017, 52(3): 581-587.
2.	Etnel JR, Elmont LC, Ertekin E, et al. Outcome after aortic valve replacement in children: A systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2016, 151(1): 143-152.
3.	Ozaki S, Kawase I, Yamashita H, et al. A total of 404 cases of aortic valve reconstruction with glutaraldehyde-treated autologous pericardium. J Thorac Cardiovasc Surg, 2014, 147(1): 301-306.
4.	Ozaki S, Kawase I, Yamashita H, et al. Midterm outcomes after aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium. J Thorac Cardiovasc Surg, 2018, 155(6): 2379-2387.
5.	Perry GJ, Helmcke F, Nanda NC, et al. Evaluation of aortic insufficiency by Doppler color flow mapping. J Am Coll Cardiol, 1987, 9(4): 952-959.
6.	Olson LJ, Subramanian R, Edwards WD. Surgical pathology of pure aortic insufficiency: a study of 225 cases. Mayo Clin Proc, 1984, 59(12): 835-841.
7.	Lin Y, Yin K, Wang Y, et al. Clinical characteristics and surgical outcomes of dysfunctional quadricuspid aortic valve. J Surg Res, 2018, 229: 223-229.
8.	Tatsuno K, Konno S, Ando M, et al. Pathogenetic mechanisms of prolapsing aortic valve and aortic regurgitation associated with ventricular septal defect. Anatomical, angiographic, and surgical considerations. Circulation, 1973, 48(5): 1028-1037.
9.	Aicher D, Holz A, Feldner S, et al. Quality of life after aortic valve surgery: replacement versus reconstruction. J Thorac Cardiovasc Surg, 2011, 142(2): e19-e24.
10.	Hörer J, Hanke T, Stierle U, et al. Neoaortic root diameters and aortic regurgitation in children after the Ross operation. Ann Thorac Surg, 2009, 88(2): 594-600.
11.	Kwak YJ, Ahn H, Choi JW, et al. Long-term results of the leaflet extension technique for rheumatic aortic regurgitation: a 20-year follow-up. Korean J Thorac Cardiovasc Surg, 2019, 52(1): 9-15.
12.	Kumar SP, Prabhakar G, Kumar M, et al. Comparison of fresh and glutaraldehyde-treated autologous stented pericardium as pulmonary valve replacement. J Card Surg, 1995, 10(5): 545-551.
13.	Manji RA, Lee W, Cooper DKC. Xenograft bioprosthetic heart valves: Past, present and future. Int J Surg, 2015, 23(Pt B): 280-284.
14.	Schmidt CE, Baier JM. Acellular vascular tissues: natural biomaterials for tissue repair and tissue engineering. Biomaterials, 2000, 21(22): 2215-2231.
15.	Meuris B, Ozaki S, Neethling W, et al. Trileaflet aortic valve reconstruction with a decellularized pericardial patch in a sheep model. J Thorac Cardiovasc Surg, 2016, 152(4): 1167-1174.

1. Vergnat M, Asfour B, Arenz C, et al. Contemporary results of aortic valve repair for congenital disease: lessons for management and staged strategy. Eur J Cardiothorac Surg, 2017, 52(3): 581-587.
2. Etnel JR, Elmont LC, Ertekin E, et al. Outcome after aortic valve replacement in children: A systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2016, 151(1): 143-152.
3. Ozaki S, Kawase I, Yamashita H, et al. A total of 404 cases of aortic valve reconstruction with glutaraldehyde-treated autologous pericardium. J Thorac Cardiovasc Surg, 2014, 147(1): 301-306.
4. Ozaki S, Kawase I, Yamashita H, et al. Midterm outcomes after aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium. J Thorac Cardiovasc Surg, 2018, 155(6): 2379-2387.
5. Perry GJ, Helmcke F, Nanda NC, et al. Evaluation of aortic insufficiency by Doppler color flow mapping. J Am Coll Cardiol, 1987, 9(4): 952-959.
6. Olson LJ, Subramanian R, Edwards WD. Surgical pathology of pure aortic insufficiency: a study of 225 cases. Mayo Clin Proc, 1984, 59(12): 835-841.
7. Lin Y, Yin K, Wang Y, et al. Clinical characteristics and surgical outcomes of dysfunctional quadricuspid aortic valve. J Surg Res, 2018, 229: 223-229.
8. Tatsuno K, Konno S, Ando M, et al. Pathogenetic mechanisms of prolapsing aortic valve and aortic regurgitation associated with ventricular septal defect. Anatomical, angiographic, and surgical considerations. Circulation, 1973, 48(5): 1028-1037.
9. Aicher D, Holz A, Feldner S, et al. Quality of life after aortic valve surgery: replacement versus reconstruction. J Thorac Cardiovasc Surg, 2011, 142(2): e19-e24.
10. Hörer J, Hanke T, Stierle U, et al. Neoaortic root diameters and aortic regurgitation in children after the Ross operation. Ann Thorac Surg, 2009, 88(2): 594-600.
11. Kwak YJ, Ahn H, Choi JW, et al. Long-term results of the leaflet extension technique for rheumatic aortic regurgitation: a 20-year follow-up. Korean J Thorac Cardiovasc Surg, 2019, 52(1): 9-15.
12. Kumar SP, Prabhakar G, Kumar M, et al. Comparison of fresh and glutaraldehyde-treated autologous stented pericardium as pulmonary valve replacement. J Card Surg, 1995, 10(5): 545-551.
13. Manji RA, Lee W, Cooper DKC. Xenograft bioprosthetic heart valves: Past, present and future. Int J Surg, 2015, 23(Pt B): 280-284.
14. Schmidt CE, Baier JM. Acellular vascular tissues: natural biomaterials for tissue repair and tissue engineering. Biomaterials, 2000, 21(22): 2215-2231.
15. Meuris B, Ozaki S, Neethling W, et al. Trileaflet aortic valve reconstruction with a decellularized pericardial patch in a sheep model. J Thorac Cardiovasc Surg, 2016, 152(4): 1167-1174.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of Ozaki operation in treatment of aortic regurgitation in children

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