The following is the of “Aortic valve neocuspidization using the Ozaki technique: A meta-analysis of reconstructed patient-level data” published in the January 2023 issue of Heart by Mylonas et al.
Ozaki neocuspid aortic valve repair in children and adults has been successful. Searches were conducted in PubMed and the Cochrane Library through the anticipated publication date of November 13, 2021. Kaplan-Meier curves for time-to-event outcomes from all relevant trials were used to recreate individual patient data for analysis. Overall, 22 studies were included detailing Ozaki repair in 1,891 patients. Patients’ ages ranged from 65 ± (12.3) to 12.3 ± (3.8) years old on average at the time of surgery, with a mean age of 43.2 ± (24.5) years.
Aortic stenosis was the leading diagnosis (46.4%, 95% CI 34.1-58.6). The average duration of the cross-clamp was 106.8 ± 24.8, while the average duration of cardiopulmonary bypass was 135.2 ± 35.1. only 0.7 % (95% CI 0.4-1.2) had a permanent pacemaker placed. The average effective orifice area was 2.1 ± 0.5 cm2/m2 at the time of discharge. In the most recent follow-up, the peak gradient was 15.7 ± 7.4 mm Hg, and only 0.25% (95% CI 0-2.3) were diagnosed with mild aortic insufficiency. With a 95% CI ranging from 0.1 to 1.7, hospital mortality was 0.7%. After a median of 38.1 ± 23.8 months of observation, the late mortality rate was 1.9%.
Reoperation-free rates at 1 year, 3 years, and 5 years averaged 98.0, 97.0, and 96.5%, respectively. Infective endocarditis was responsible for more than half of the reoperations (51.5%, 95% CI 18.3-84.0). Their group had a yearly endocarditis risk of 0.5% per patient. The Ozaki method has proven to be highly effective in terms of hemodynamics, survival, and absence of reoperation at mid-term. Gaining access to long-term follow-up data is crucial for establishing this method as a standard in cardiac surgery.