Hostname: page-component-54dcc4c588-rz4zl Total loading time: 0 Render date: 2025-10-11T05:40:46.932Z Has data issue: false hasContentIssue false

Application of Ozaki technique in the treatment of aortic valve disease in children: a 15-year retrospective review

Published online by Cambridge University Press:  18 August 2025

Zhangwei Wang
Affiliation:
Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
Honghao Fu
Affiliation:
Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
Shoujun Li*
Affiliation:
Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
*
Corresponding author: Shoujun Li; Email: beijing348@qq.com

Abstract

With the steady improvement in the efficacy of Ozaki technique in children over the past decade, it is more active and widely used in children with aortic valve disease. Ozaki technique has obvious advantages over traditional prosthetic valve replacement. It preserves the natural motion of the aortic annulus, preserves the coordination of the left ventricle, the sinus of Valsalva and the aorta, naturally dilates the aortic root during systole, restores the physiological laminar flow pattern, and retains the continuous growth potential of the aortic annulus. It has good early and mid-term valve durability, no need for anticoagulation, short learning curve time, easy to promote, suitable for a wide range of people, and significant economic benefits, especially in developing countries with serious shortage of medical resources but a large number of CHD patients. Theoretically, Ozaki techniques can be considered in patients of all ages (adults and children) and in those with acquired and congenital aortic valve disease, including those with previous mechanical, bioprosthetic, or Ross procedures. We currently support the concept of using Ozaki technique as a surgical repair method for children with severe aortic valve disease, but the specific strategy should be made individually according to the patient’s condition. This article reviews the past and present, surgical indications, surgical procedures, advantages, prognosis, and prospects of Ozaki technique in treating aortic valve disease in children.

Information

Type
Review
Copyright
© The Author(s), 2025. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Zhangwei Wang and Honghao Fu contributed equally to this work.

References

Yasuhara, J, Schultz, K, Bigelow, AM, Garg, V. Congenital aortic valve stenosis: from pathophysiology to molecular genetics and the need for novel therapeutics. Front Cardiovasc Med 2023; 10: 1142707.CrossRefGoogle ScholarPubMed
Zhang, H, Yang, K, Chen, X, Dong, N, Li, S. National society of congenital heart diseases. Chinese expert consensus on surgical treatment of aortic valve disease in children. Chin J Clin Thorac Cardiovasc Surg 2024; 31: 15601566.Google Scholar
Xie, L, Wu, Z, Liu, J, Dian, K. Short- to mid-term outcomes of aortic valve plasty versus Ross procedure in children with severe aortic valve disease: a retrospective cohort study. Chin J Clin Thorac Cardiovasc Surg 2024; 31: 17941802.Google Scholar
Myers, PO, Mokashi, SA, Horgan, E, et al. Outcomes after mechanical aortic valve replacement in children and young adults with congenital heart disease. J Thorac Cardiov Sur 2019; 157: 329340.CrossRefGoogle Scholar
Etnel, JR, Elmont, LC, Ertekin, E, et al. Outcome after aortic valve replacement in children: a systematic review and meta-analysis. J Thorac Cardiov Sur 2016; 151: 143152.CrossRefGoogle ScholarPubMed
Sharabiani, MT, Dorobantu, DM, Mahani, AS, et al. Aortic valve replacement and the Ross operation in children and young adults. J Am Coll Cardiol 2016; 67: 28582870.CrossRefGoogle ScholarPubMed
Fukushima, S, Tesar, PJ, Pearse, B, et al. Long-term clinical outcomes after aortic valve replacement using cryopreserved aortic allograft. J Thorac Cardiov Sur 2014; 148: 6572.CrossRefGoogle ScholarPubMed
Mazine, A, El-Hamamsy, I, Verma, S, et al. Ross procedure in adults for cardiologists and cardiac surgeons JACC State-of-the-Art Review. J Am Coll Cardiol 2018; 72: 27612777.CrossRefGoogle ScholarPubMed
Wang, GX, Zhang, S, Ma, K, et al. Ozaki technique versus Ross operation for complex aortic valve diseases in children: a retrospective cohort study. Int J Surg 2025; 111: 113121.CrossRefGoogle ScholarPubMed
Zhu, M, Konstantinov, IE, Wu, DM, Wallace, F, Brizard, CP, Buratto, E. Aortic valve repair versus the ross procedure in children. J Thorac Cardiov Sur 2023; 166: 12791288.CrossRefGoogle ScholarPubMed
Bouhout, I, Ba, PS, El-Hamamsy, I, Poirier, N. Aortic valve interventions in pediatric patients. Semin Thorac Cardiov 2019; 31: 277287.CrossRefGoogle ScholarPubMed
Vergnat, M, Asfour, B, Arenz, C, et al. Aortic stenosis of the neonate: a single-center experience. J Thorac Cardiov Sur 2019; 157: 318326.CrossRefGoogle ScholarPubMed
Siddiqui, J, Brizard, CP, Galati, JC, et al. Surgical valvotomy and repair for neonatal and infant congenital aortic stenosis achieves better results than interventional catheterization. J Am Coll Cardiol 2013; 62: 21342140.CrossRefGoogle ScholarPubMed
Ozaki, S, Kawase, I, Yamashita, H, Uchida, S, Takatoh, M, Kiyohara, N. Midterm outcomes after aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium. J Thorac Cardiov Sur 2018; 155: 23792387.CrossRefGoogle ScholarPubMed
Ozaki, S, Kawase, I, Yamashita, H, et al. Aortic valve reconstruction using self-developed aortic valve plasty system in aortic valve disease. Interact Cardiov Th 2011; 12: 550553.Google ScholarPubMed
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: e27391.CrossRefGoogle Scholar
Baird, CW, Marathe, SP, Del, NP. Aortic valve neo-cuspidation using the Ozaki technique for acquired and congenital disease: where does this procedure currently stand? Indian J Thorac Card 2020; 36: 113122.Google ScholarPubMed
Amabile, A, Krane, M, Dufendach, K, et al. Standardized aortic valve neocuspidization for treatment of aortic valve diseases. Ann Thorac Surg 2022; 114: 11081117.CrossRefGoogle ScholarPubMed
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-card Img 2022; 23: 275282.Google ScholarPubMed
Sivalingam, S, Haranal, MY, See, WS. Factors predicting early outcome of aortic valve neocuspidization in the pediatric population. Pediatr Cardiol 2025; DOI: 10.1007/s00246-025-03808-6.CrossRefGoogle Scholar
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: 301306.CrossRefGoogle ScholarPubMed
Baird, CW, Cooney, B, Chavez, M, Sleeper, LA, Marx, GR, Del, NP. Congenital aortic and truncal valve reconstruction using the Ozaki technique: short-term clinical results. J Thorac Cardiov Sur 2021; 161: 15671577.CrossRefGoogle ScholarPubMed
Marathe, SP, Chavez, M, Sleeper, LA, et al. Single-leaflet aortic valve reconstruction utilizing the Ozaki technique in patients with congenital aortic valve disease. Semin Thorac Cardiov 2022; 34: 12621272.CrossRefGoogle ScholarPubMed
Marathe, SP, Chavez, M, Sleeper, LA, Marx, G, Del, NP, Baird, CW. Modified Ozaki procedure including annular enlargement for small aortic annuli in young patients. Ann Thorac Surg 2020; 110: 13641371.CrossRefGoogle ScholarPubMed
Wiggins, LM, Mimic, B, Issitt, R, et al. The utility of aortic valve leaflet reconstruction techniques in children and young adults. J Thorac Cardiov Sur 2020; 159: 23692378.CrossRefGoogle ScholarPubMed
Polito, A, Albanese, SB, Cetrano, E, Cicenia, M, Rinelli, G, Carotti, A. Aortic valve neocuspidalization in paediatric patients with isolated aortic valve disease: early experience. Interact Cardiov Th 2021; 32: 111117.Google ScholarPubMed
Polito, A, Albanese, SB, Cetrano, E, et al. Aortic valve neocuspidalization may Be a viable alternative to ross operation in pediatric patients. Pediatr Cardiol 2021; 42: 668675.CrossRefGoogle ScholarPubMed
Cicek, M, Ozdemir, F. Aortic valve neocuspidization with the Ozaki procedure in congenital aortic valve disease: early results. Turk Gogus Kalp Dama 2023; 31: 431439.CrossRefGoogle ScholarPubMed
Huang, J, Zhang, W, Jia, B, et al. A midterm follow-up study of the application of a confluent aortic valve neocuspidization technique with pericardium in children. Transl Pediatr 2023; 12: 19811991.CrossRefGoogle ScholarPubMed
Kalezi, ZE, Simbila, AN, Mongella, S, et al. Outcomes post Ozaki procedure among children with aortic valve disease at Jakaya Kikwete cardiac institute, Dar es Salaam, Tanzania: a retrospective descriptive study. Bmc Cardiovasc Disor 2024; 24: 163.CrossRefGoogle Scholar
Zhang, W, Jiang, Q, Liu, Y, et al. Surgical outcomes of aortic valve replacement in children with Ross and Ozaki procedure. Eur J Cardio-thorac 2025; 67: ezaf088. DOI: 10.1093/ejcts/ezaf088.CrossRefGoogle ScholarPubMed
Ogami, T, Dufendach, KA, Imran, M, et al. Midterm Outcomes After Aortic Valve Neocuspidization (Ozaki Procedure) in Adults. Ann Thorac Surg 2024; 117: 789795.CrossRefGoogle ScholarPubMed
Yamamoto, Y, Iino, K, Shintani, Y, et al. Comparison of aortic annulus dimension after aortic valve neocuspidization with valve replacement and normal valve. Semin Thorac Cardiov 2017; 29: 143149.CrossRefGoogle ScholarPubMed
Kalfa, D, LaPar, D, Chai, P, Bacha, E. Aortic valve neocuspidization: a bright future in pediatric aortic valve surgery? J Thorac Cardiov Sur 2019; 157: 728.CrossRefGoogle ScholarPubMed
Dvir, D, Bourguignon, T, Otto, CM, et al. Standardized definition of structural valve degeneration for surgical and transcatheter bioprosthetic aortic valves. Circulation 2018; 137: 388399.CrossRefGoogle ScholarPubMed
Wang, Z, Ma, K, Li, S. Application of right ventricular to pulmonary valved conduit in the surgical treatment of congenital heart disease. Cardiol Young 2024; 34: 14031410.CrossRefGoogle ScholarPubMed
Bazylev, V, Tungusov, D, Mikulyak, A. Predictors of mid-term AVNeo insufficiency. Braz J Cardiov Surg 2023; 38: e20220370.CrossRefGoogle ScholarPubMed
Myers, PO, Tissot, C, Christenson, JT, Cikirikcioglu, M, Aggoun, Y, Kalangos, A. Aortic valve repair by cusp extension for rheumatic aortic insufficiency in children: long-term results and impact of extension material. J Thorac Cardiov Sur 2010; 140: 836844.CrossRefGoogle ScholarPubMed
Ranucci, M, Frigiola, A, Menicanti, L, Castelvecchio, S, de Vincentiis, C, Pistuddi, V. Aortic cross-clamp time, new prostheses, and outcome in aortic valve replacement. J Heart Valve Dis 2012; 21: 732739.Google ScholarPubMed
Miller, PC, Miller, JR, Mannie, CT, Nath, DS, Eghtesady, P. Right Atrial Appendage for Aortic Valve Reconstruction. Ann Thorac Surg 2025; 120: 7986. DOI: 10.1016/j.athoracsur.2025.03.035.CrossRefGoogle ScholarPubMed