Effect of aortic valve neo-cuspidization in multiple valve repair surgery: A retrospective cohort study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Zhou , ZHANG Yazhe , HAN Jie , JIANG Wenjian ,  ZHANG Hongjia

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P. R. China;

Corresponding author：

ZHANG Hongjia, Email: zhanghongjia722@ccmu.edu.cn

Keywords：

Aortic valve neo-cuspidization; multiple valve repair; retrospective cohort study

DOI：

10.7507/1007-4848.202312034

Video：

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Objective To explore the effect of aortic valve neo-cuspidization (AVNeo) for patients with severe aortic valve lesions simultaneously. Methods Patients who underwent AVNeo combined valve repair surgery for multiple valve diseases were included in Beijing Anzhen Hospital from May 2016 to September 2023. Results We included 11 patients with 7 males and 4 females at a median age of 38 (36, 49) years. Rheumatic heart disease was found in 5 (45.5%) patients and non-rheumatic heart disease in 6 (54.5%) patients. The median EuroSCORE Ⅱ score was 1.62 (1.18, 1.75) points. Eight patients underwent AVNeo plus mitral and tricuspid valve repair, and 3 patients underwent AVNeo plus mitral valve repair. The median operative time was 356 (315, 415) min, and the median cardiopulmonary bypass time and aortic clamping time were 203 (174, 231) min and 168 (131, 188) min, respectively. In the early stage, 2 patients underwent combined valve repair surgery, and 1 patient underwent in-hospital reoperation for aortic valve replacement because of severe aortic regurgitation. There were 9 patients in the mature stage of AVNeo, and no perioperative adverse events or moderate or above residual valvular disease occurred. All patients recovered and were discharged from the hospital. The follow-up period was 3-99 months, and no reoperation, severe valve disease, bleeding, cerebral infarction, or other adverse events occurred in all patients. Conclusion For non-elderly patients whose mitral and tricuspid valves can be repaired successfully with severe aortic valve lesions, AVNeo can be attempted after proficiency. But the operation time and cardiopulmonary bypass time will inevitably be prolonged, and the patient's basic situation should be carefully evaluated before surgery.

Citation： LIU Zhou, ZHANG Yazhe, HAN Jie, JIANG Wenjian, ZHANG Hongjia. Effect of aortic valve neo-cuspidization in multiple valve repair surgery: A retrospective cohort study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(6): 853-859. doi: 10.7507/1007-4848.202312034 Copy

1.	Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J, 2003, 24(13): 1231-1243.
2.	Lee R, Li S, Rankin JS, et al. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg, 2011, 91(3): 677-684.
3.	Coutinho GF, Antunes MJ. Mitral valve repair for degenerative mitral valve disease: Surgical approach, patient selection and long-term outcomes. Heart, 2017, 103(21): 1663-1669.
4.	Kim WK, Kim HJ, Kim JB, et al. Clinical outcomes in 1731 patients undergoing mitral valve surgery for rheumatic valve disease. Heart, 2018, 104(10): 841-848.
5.	Fu J, Li Y, Zhang H, et al. Outcomes of mitral valve repair compared with replacement for patients with rheumatic heart disease. J Thorac Cardiovasc Surg, 2021, 162(1): 72-82.
6.	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.
7.	Unai S, Ozaki S, Johnston DR, et al. Aortic valve reconstruction with autologous pericardium versus a bioprosthesis: The Ozaki procedure in perspective. J Am Heart Assoc, 2023, 12(2): e027391.
8.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
9.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
10.	中华医学会胸心血管外科分会瓣膜病外科学组. 心脏瓣膜外科抗凝治疗中国专家共识. 中华胸心血管外科杂志, 2022, 38(3): 164-174.
11.	中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2021概要. 中国循环杂志, 2022, 37(6): 553-578.
12.	Gillinov M, Burns DJP, Wierup P. Commentary: Mitral valve repair wins again. J Thorac Cardiovasc Surg, 2021, 162(1): 83.
13.	Benedetto U, Sinha S, Dimagli A, et al. Aortic valve neocuspidization with autologous pericardium in adult patients: UK experience and meta-analytic comparison with other aortic valve substitutes. Eur J Cardiothorac Surg, 2021, 60(1): 34-46.
14.	Mylonas KS, Tasoudis PT, Pavlopoulos D, et al. Aortic valve neocuspidization using the Ozaki technique: A meta-analysis of reconstructed patient-level data. Am Heart J, 2023, 255: 1-11.
15.	Unai S, Ozaki S, Hoshino Y, et al. Outcome of 1196 aortic valve reconstruction—The Ozaki procedure. The American Association for Thoracic Surgery 103th Annual Meeting, 2023.
16.	Boodhwani M, de Kerchove L, Glineur D, et al. Repair-oriented classification of aortic insufficiency: Impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg, 2009, 137(2): 286-294.
17.	李岩, 付金涛, 焦玉清, 等. 主动脉瓣修复术治疗风湿性主动脉瓣病变的术后中期疗效评估. 中华胸心血管外科杂志, 2021, 37(8): 467-471.
18.	韩杰, 李岩, 田白羽, 等. 自体心包主动脉瓣成形术近期效果的单中心研究. 中华胸心血管外科杂志, 2017, 33(11): 670-672.
19.	Amabile A, Krane M, Dufendach K, et al. Standardized aortic valve neocuspidization for treatment of aortic Valve diseases. Ann Thorac Surg, 2022, 114(4): 1108-1117.
20.	Akiyama S, Iida Y, Shimura K, et al. Midterm outcome of aortic valve neocuspidization for aortic valve stenosis with small annulus. Gen Thorac Cardiovasc Surg, 2020, 68(8): 762-767.
21.	Head SJ, Mokhles MM, Osnabrugge RL, et al. The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: A systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years. Eur Heart J, 2012, 33(12): 1518-1529.
22.	Sakamoto Y, Hashimoto K. Update on aortic valve prosthesis-patient mismatch in Japan. Gen Thorac Cardiovasc Surg, 2013, 61(12): 669-675.
23.	Watanabe Y, Hayashida K, Takayama M, et al. First direct comparison of clinical outcomes between European and Asian cohorts in transcatheter aortic valve implantation: The Massy study group vs. the PREVAIL JAPAN trial. J Cardiol, 2015, 65(2): 112-116.
24.	Freitas-Ferraz AB, Tirado-Conte G, Dagenais F, et al. Aortic stenosis and small aortic annulus. Circulation, 2019, 139(23): 2685-2702.
25.	Ghoneim A, Bouhout I, Demers P, et al. Management of small aortic annulus in the era of sutureless valves: A comparative study among different biological options. J Thorac Cardiovasc Surg, 2016, 152(4): 1019-1028.
26.	Pibarot P, Dumesnil JG. Prosthesis-patient mismatch: Definition, clinical impact, and prevention. Heart, 2006, 92(8): 1022-1029.
27.	Wiggins LM, Mimic B, Issitt R, et al. The utility of aortic valve leaflet reconstruction techniques in children and young adults. J Thorac Cardiovasc Surg, 2020, 159(6): 2369-2378.
28.	Secinaro A, Milano EG, Ciancarella P, et al. Blood flow characteristics after aortic valve neocuspidization in paediatric patients: A comparison with the Ross procedure. Eur Heart J Cardiovasc Imaging, 2022, 23(2): 275-282.
29.	Tada N, Tanaka N, Abe K, et al. Transcatheter aortic valve implantation after aortic valve neocuspidization using autologous pericardium: A case report. Eur Heart J Case Rep, 2019, 3(3): ytz105.
30.	Khan JM, Greenbaum AB, Babaliaros VC, et al. The BASILICA trial: Prospective multicenter investigation of intentional leaflet laceration to prevent TAVR coronary obstruction. JACC Cardiovasc Interv, 2019, 12(13): 1240-1252.

1. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J, 2003, 24(13): 1231-1243.
2. Lee R, Li S, Rankin JS, et al. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg, 2011, 91(3): 677-684.
3. Coutinho GF, Antunes MJ. Mitral valve repair for degenerative mitral valve disease: Surgical approach, patient selection and long-term outcomes. Heart, 2017, 103(21): 1663-1669.
4. Kim WK, Kim HJ, Kim JB, et al. Clinical outcomes in 1731 patients undergoing mitral valve surgery for rheumatic valve disease. Heart, 2018, 104(10): 841-848.
5. Fu J, Li Y, Zhang H, et al. Outcomes of mitral valve repair compared with replacement for patients with rheumatic heart disease. J Thorac Cardiovasc Surg, 2021, 162(1): 72-82.
6. 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.
7. Unai S, Ozaki S, Johnston DR, et al. Aortic valve reconstruction with autologous pericardium versus a bioprosthesis: The Ozaki procedure in perspective. J Am Heart Assoc, 2023, 12(2): e027391.
8. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
9. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
10. 中华医学会胸心血管外科分会瓣膜病外科学组. 心脏瓣膜外科抗凝治疗中国专家共识. 中华胸心血管外科杂志, 2022, 38(3): 164-174.
11. 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2021概要. 中国循环杂志, 2022, 37(6): 553-578.
12. Gillinov M, Burns DJP, Wierup P. Commentary: Mitral valve repair wins again. J Thorac Cardiovasc Surg, 2021, 162(1): 83.
13. Benedetto U, Sinha S, Dimagli A, et al. Aortic valve neocuspidization with autologous pericardium in adult patients: UK experience and meta-analytic comparison with other aortic valve substitutes. Eur J Cardiothorac Surg, 2021, 60(1): 34-46.
14. Mylonas KS, Tasoudis PT, Pavlopoulos D, et al. Aortic valve neocuspidization using the Ozaki technique: A meta-analysis of reconstructed patient-level data. Am Heart J, 2023, 255: 1-11.
15. Unai S, Ozaki S, Hoshino Y, et al. Outcome of 1196 aortic valve reconstruction—The Ozaki procedure. The American Association for Thoracic Surgery 103th Annual Meeting, 2023.
16. Boodhwani M, de Kerchove L, Glineur D, et al. Repair-oriented classification of aortic insufficiency: Impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg, 2009, 137(2): 286-294.
17. 李岩, 付金涛, 焦玉清, 等. 主动脉瓣修复术治疗风湿性主动脉瓣病变的术后中期疗效评估. 中华胸心血管外科杂志, 2021, 37(8): 467-471.
18. 韩杰, 李岩, 田白羽, 等. 自体心包主动脉瓣成形术近期效果的单中心研究. 中华胸心血管外科杂志, 2017, 33(11): 670-672.
19. Amabile A, Krane M, Dufendach K, et al. Standardized aortic valve neocuspidization for treatment of aortic Valve diseases. Ann Thorac Surg, 2022, 114(4): 1108-1117.
20. Akiyama S, Iida Y, Shimura K, et al. Midterm outcome of aortic valve neocuspidization for aortic valve stenosis with small annulus. Gen Thorac Cardiovasc Surg, 2020, 68(8): 762-767.
21. Head SJ, Mokhles MM, Osnabrugge RL, et al. The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: A systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years. Eur Heart J, 2012, 33(12): 1518-1529.
22. Sakamoto Y, Hashimoto K. Update on aortic valve prosthesis-patient mismatch in Japan. Gen Thorac Cardiovasc Surg, 2013, 61(12): 669-675.
23. Watanabe Y, Hayashida K, Takayama M, et al. First direct comparison of clinical outcomes between European and Asian cohorts in transcatheter aortic valve implantation: The Massy study group vs. the PREVAIL JAPAN trial. J Cardiol, 2015, 65(2): 112-116.
24. Freitas-Ferraz AB, Tirado-Conte G, Dagenais F, et al. Aortic stenosis and small aortic annulus. Circulation, 2019, 139(23): 2685-2702.
25. Ghoneim A, Bouhout I, Demers P, et al. Management of small aortic annulus in the era of sutureless valves: A comparative study among different biological options. J Thorac Cardiovasc Surg, 2016, 152(4): 1019-1028.
26. Pibarot P, Dumesnil JG. Prosthesis-patient mismatch: Definition, clinical impact, and prevention. Heart, 2006, 92(8): 1022-1029.
27. Wiggins LM, Mimic B, Issitt R, et al. The utility of aortic valve leaflet reconstruction techniques in children and young adults. J Thorac Cardiovasc Surg, 2020, 159(6): 2369-2378.
28. Secinaro A, Milano EG, Ciancarella P, et al. Blood flow characteristics after aortic valve neocuspidization in paediatric patients: A comparison with the Ross procedure. Eur Heart J Cardiovasc Imaging, 2022, 23(2): 275-282.
29. Tada N, Tanaka N, Abe K, et al. Transcatheter aortic valve implantation after aortic valve neocuspidization using autologous pericardium: A case report. Eur Heart J Case Rep, 2019, 3(3): ytz105.
30. Khan JM, Greenbaum AB, Babaliaros VC, et al. The BASILICA trial: Prospective multicenter investigation of intentional leaflet laceration to prevent TAVR coronary obstruction. JACC Cardiovasc Interv, 2019, 12(13): 1240-1252.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of aortic valve neo-cuspidization in multiple valve repair surgery: A retrospective cohort study in a single center

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