Blood flow characteristics after aortic valve neocuspidization in paediatric patients: a comparison with the Ross procedure.

Published on Feb 7, 2021in European Journal of Echocardiography4.841
· DOI :10.1093/EHJCI/JEAB009
Aurelio Secinaro10
Estimated H-index: 10
(Boston Children's Hospital),
Elena Giulia Milano5
Estimated H-index: 5
(UCL: University College London)
+ 9 AuthorsAdriano Carotti25
Estimated H-index: 25
(Boston Children's Hospital)
AIMS The aortic valve (AV) neocuspidization (Ozaki procedure) is a novel surgical technique for AV disease that preserves the natural motion and cardiodynamics of the aortic root. In this study, we sought to evaluate, by 4D-flow magnetic resonance imaging, the aortic blood flow characteristics after AV neocuspidization in paediatric patients. METHODS AND RESULTS Aortic root and ascending aorta haemodynamics were evaluated in a population of patients treated with the Ozaki procedure; results were compared with those of a group of patients operated with the Ross technique. Cardiovascular magnetic resonance studies were performed at 1.5 T using a 4D flow-sensitive sequence acquired with retrospective electrocardiogram-gating and respiratory navigator. Post-processing of 4D-flow analysis was performed to calculate flow eccentricity and wall shear stress. Twenty children were included in this study, 10 after Ozaki and 10 after Ross procedure. Median age at surgery was 10.7 years (range 3.9-16.5 years). No significant differences were observed in wall shear stress values measured at the level of the proximal ascending aorta between the two groups. The analysis of flow patterns showed no clear association between eccentric flow and the procedure performed. The Ozaki group showed just a slightly increased transvalvular maximum velocity. CONCLUSION Proximal aorta flow dynamics of children treated with the Ozaki and the Ross procedure are comparable. Similarly to the Ross, Ozaki technique restores a physiological laminar flow pattern in the short-term follow-up, with the advantage of not inducing a bivalvular disease, although further studies are warranted to evaluate its long-term results.
#1Christopher W. Baird (Boston Children's Hospital)H-Index: 23
#2Brenda Cooney (Boston Children's Hospital)H-Index: 1
Last. Pedro J. del Nido (Boston Children's Hospital)H-Index: 87
view all 6 authors...
Abstract Objectives Aortic valve reconstruction (AVRec) with neo-cuspidization or the Ozaki procedure with complete cusp replacement for aortic valve disease has excellent mid-term results in adults. Limited results of AVRec in pediatric patients have been reported. We report our early outcomes of the Ozaki procedure for congenital aortic and truncal valve disease. Methods Retrospective analysis was performed on all 57 patients with congenital aortic and truncal valve disease that had a three le...
16 CitationsSource
#1Angelo Polito (University of Geneva)H-Index: 3
#2Sonia B. Albanese (Boston Children's Hospital)H-Index: 13
Last. Adriano Carotti (Boston Children's Hospital)H-Index: 25
view all 7 authors...
The aim of the study was to evaluate the medium-term results of aortic valve neocuspidalization according to Ozaki compared to Ross procedure for treatment of isolated aortic valve disease in pediatric age. Thirty-eight consecutive patients with congenital or acquired aortic valve disease underwent either Ozaki (n = 22) or Ross (n = 16) operation between 01/2015 and 05/2020. The primary outcome was progression of aortic valve disease and aortic ring and root dimension, whereas secondary outcome ...
1 CitationsSource
#1Angelo Polito (University of Geneva)H-Index: 3
#2Sonia B. Albanese (Boston Children's Hospital)H-Index: 13
Last. Adriano Carotti (Boston Children's Hospital)H-Index: 25
view all 6 authors...
OBJECTIVES There is growing interest in the aortic valve (AV) neocuspidalization technique for the treatment of aortic valve disease (AVD). We report our medium-term results with this procedure performed in a paediatric patient population. METHODS Between July 2016 and May 2020, 22 patients with both congenital and acquired isolated AVD were treated with neocuspidalization. The primary outcome was progression of the preoperatively assessed AVD in the immediate postoperative course and at follow-...
3 CitationsSource
#1Luke M. Wiggins (GOSH: Great Ormond Street Hospital)H-Index: 2
#1Luke M. Wiggins (GOSH: Great Ormond Street Hospital)H-Index: 1
Last. Martin Kostolny (GOSH: Great Ormond Street Hospital)H-Index: 22
view all 7 authors...
Abstract Objectives The treatment of aortic valve disease in children and adolescents requires an individualized approach to provide a long-term solution with optimal hemodynamic profile. The role of aortic leaflet reconstruction techniques is evolving. Methods We retrospectively reviewed the charts of 58 patients who underwent aortic valve tri-cuspidalization either by an Ozaki procedure (neo-tricuspidalisation) or single leaflet reconstruction (SLR) between 2015-2019. Immediate operative resul...
22 CitationsSource
#1Sian Chivers (NIH: National Institutes of Health)H-Index: 2
#2Carine Pavy (NIH: National Institutes of Health)H-Index: 2
Last. Piers E.F. Daubeney (NIH: National Institutes of Health)H-Index: 30
view all 6 authors...
Background:The Ozaki procedure is a surgical technique for patients with significant aortic stenosis or regurgitation or both where valve repair cannot be performed. Individual cusps are cut from g...
12 CitationsSource
#1Michael J. Rose (Children's Memorial Hospital)H-Index: 7
#2Cynthia K. Rigsby (NU: Northwestern University)H-Index: 25
Last. Michael Markl (NU: Northwestern University)H-Index: 83
view all 10 authors...
Background Children with bicuspid aortic valve (BAV) are at risk for serious complications including aortic valve stenosis and aortic rupture. Most studies investigating biomarkers predictive of BAV complications are focused on adults.
9 CitationsSource
With the use of four-dimensional flow MRI and postprocessing, accurate direct measurement of wall shear stress (WSS) was performed in a population of normal thoracic aortas (n = 224). WSS was highe...
16 CitationsSource
#1Shigeyuki Ozaki (Toho University)H-Index: 13
#2Isamu Kawase (Toho University)H-Index: 12
Last. Nagaki Kiyohara (Toho University)H-Index: 5
view all 6 authors...
Abstract Objective We had previously reported the short-term results of the aortic valve neocuspidization (AVNeo) procedure. We have now evaluated the midterm results with the longest follow-up of 118 months. Methods From April 2007 through December 2015, 850 patients were treated with AVNeo using autologous pericardium. Medical records of these patients were retrospectively reviewed. The procedure was on the basis of independent tricuspid replacement using autologous pericardium. The distances ...
91 CitationsSource
#1Malenka M Bissell (University of Oxford)H-Index: 14
#2Margaret Loudon (University of Oxford)H-Index: 9
Last. Saul G. Myerson (University of Oxford)H-Index: 7
view all 7 authors...
Background Abnormal aortic flow patterns in bicuspid aortic valve disease (BAV) may be partly responsible for the associated aortic dilation. Aortic valve replacement (AVR) may normalize flow patterns and potentially slow the concomitant aortic dilation. We therefore sought to examine differences in flow patterns post AVR.
24 CitationsSource
#1William A. Zoghbi (Houston Methodist Hospital)H-Index: 67
#2David J. Adams (Duke University)H-Index: 106
Last. Neil J. Weissman (MedStar Health)H-Index: 81
view all 16 authors...
1,062 CitationsSource
Cited By1