Modified Ozaki procedure including annular enlargement for small aortic annuli in young patients.

Abstract Background Aortic valve neo-cuspidization (AVNeo, Ozaki procedure) has excellent mid-term results in adults. Outcomes in patients with a small native aortic annulus are unknown. We report early outcomes in young patients with small native aortic valve annuli. Methods Retrospective review of patients undergoing AVNeo between 2015-2019 were reviewed. Patients with native aortic annulus ≤21 mm undergoing 3-leaflet AVNeo were included. Results 51 patients were identified (median age 7.9 years, weight 21 kg). 80% patients were ≤12 years age. Pre-operative indication was AR (n=23), AS (n=22) or AS/AR (n=6). Baseline anatomy was: quadricuspid (n=1), tricuspid (n=23), bicuspid (n=15) or unicuspid (n=12) valve. Pre-operative peak gradient for AS and AS/AR patients was 55.36 mmHg. Median native annulus diameter was 17 mm; sinus and annular enlargements were required in 22 and 9 patients, respectively. Median ICU and hospital length of stay were 2.0 and 7.2 days, respectively. There were no re-interventions and one hospital mortality unrelated to aortic valve. At discharge, 94% of patients had ≤mild AR and median peak gradient was 18 mmHg. At mean follow-up of 11.9 months, 80% and 82% of patients had 0 at follow-up. Conclusions The Ozaki procedure has acceptable short-term results in young patients with small aortic annuli. A larger aortic annulus can be achieved with surgical annular enlargement. Long-term follow-up is necessary to determine late valve function and potential continued annular growth.