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II. ХИРУРГИЯ
RESULTS OF AORTIC VALVE REPLACEMENT USING AUTOLOGOUS PERICARDIUM BY OZAKI TECHNIQUE. REVIEW OF LITERATURE
UDC 614.2-616.24-089-616082
МРНТИ 76.29.30
Sagatov I.Y., Momynov B.M.
JSC "National scientific center of surgery named after A.N. Syzganov", Almaty, Kazakhstan
ABOUT THEАUTHORS
Sagatov Inkar Yergalievich - Department head of SRW management of the JSC "NSCS named after A.N. Syzganov", doctor of medical sciences.
Momynov Bahytzhan Meirambekovich
- resident of specialty "Cardiac surgery and child cardiac surgery" of the JSC "NSCS named after A.N. Syzganov".
Abstract
A review of the results of aortic valve replacement using autologous pericardium was carried out using -
the Ozaki technique. The article shows data on 30-day and long-term mortality, the percentage of aortic K .
stenosis or regurgitation due to Ozaki surgery, freedom from reoperation, as well as the mean and peak aoryc valve autoiogous
gradient on the aortic valve according to various authors.
Ozaki эдюмен аутологиялык перикардты колдану аркылы колка какпакшасын алмастыру нэтижелерк Эдебиет шолуы
pericardium, results
СаFатов I.E., Момынов Б.М.
«А.Н. Сыз?анов атында?ы Улттык ?ылыми хирургия орталь™» АК, Алматы, Казакстан
Ацдатпа
Ozaki afflci бойынша взiндiк пeрикaрды колдану аркылы колка какпакшасын ауыстыру нэrижeлeрiнe шолу жасалынган. Макалада эрrYрлi авторлардьщ мэлiмerreрiнe œrnec 30-кундк жэнe алшак вл'ш-жтм, Ozaki отасынан ^'mn колка тарылуы жэнe рeгургитaциясыныц кeздeсу жилю, отага кайта тYсудeн бостандык, сондай-ак, колка какпащасындагы орташа жэнe пиктк грaдиeнтreрi кврсeriлгeн.
АВТОРЛАР ТУРАЛЫ
Сагатов 1цкар Ергалиулы - «А.Н. Сызганов атныдары YFXO» А^-нын ¥ЗЖ менеджмент бeлiмiнiн басшысы, медицина Fылымдapынын докторы.
Момынов Бачытжан Мейрамбекулы
- «Кардиохирургия, онын шнде балалар» мамандь^ы бойынша «А.Н. СызFaнов атныдары YFXO» А^-нын рeзидeнтi.
Туйш свздер
колка какпакшасы, взiндiк перикард, нэтижелеpi
Результаты замены аортального клапана с использованием аутологичного перикарда по методике Ozaki. Обзор литературы
ОБ АВТОРАХ
Сагатов И.Е., Момынов Б.М.
АО «Национальный научный центр хирургии им. А.Н. Сызганова», Алматы, Казахстан
Сагатов Инкар Ергалиевич -
тель отдела менеджмента НИР АО «ННЦХ им. А.Н. Сызганова», доктор медицинских наук.
Момынов Бахытжан Мейрамбекович
- резидент по специальности «Кардиохирургия, в т.ч. детская» АО «ННЦХ им. А.Н. Сызганова»
Аннотация
Проведен обзор результатов замены аортального клапана с использованием аутологичного перикарда по методике Огак!. В статье показаны данные о 30-дневной и отдаленной летальности, процент наличия аортального стеноза илирегургитации после операции Огак!, свобода отреоперации, а также средний и пиковый градиент на аортальном клапане по данным различных авторов.
Ключевые слова
аортальный клапан, аутологич-ный перикард, результаты
Background
Aortic valve construction using pericardial tissue has been known since the late 1960s. The procedure was reintroduced by Ozaki in 2010 and is currently used to treat specific aortic valve diseases. The exact sizing of the neo-cusps and the insertion of the commissures remain the keys to success when performing this procedure [2-7].
Discussion
The largest number of operations and the study of their immediate and long-term results of treatment belongs to the author of the method of replacing the aortic valve using an autologous pericardium, the Japanese heart surgeon Ozaki. According to him, the 30-day mortality rate after Ozaki surgery ranges from 0 to 3.5%, depending on the age category of the operated patients [10-16]. Other authors point to the same corridor of fluctuations in 30-day mortality - from 1.9 to 3.3% [9, 17].
Long-term results of Ozaki surgery were assessed by the absence or presence of aortic stenosis, regurgitation on the aortic valve, freedom from reoperation, and average and peak gradient values on the aortic valve. It should be noted that almost the majority of authors indicate a complete absence of stenosis of the aortic valve in the long term after surgery Ozaki. Long-term mortality in the Ozaki procedure ranges from 0-13.0% [9-16].
Aortic valve repair is possible due to low mortality in many patients with aortic regurgitation. This shows better results in terms of freedom from valve-related complications compared to conventional aortic valve replacement. Important milestones in the development of aortic valve repair have already been achieved as it becomes a viable alternative to aortic valve replacement in patients with aortic regurgita-
tion. The origin of aortic valve repair can be traced back to the early era of cardiac surgery. Aortic valve restoration was performed using native valve cusps using various methods, which include commissur-otomy, annuloplasty, expansion of the free edge, resuspension of the valve, reinforcement of the supra-ortal crest, reinforcement of the free edge, resection of the wedge, and so on. This type of conservative recovery is not always possible, especially for calcified AS in elderly patients. Simple decalcification or cutting of tubercles did not show good results. On the other hand, there is an obvious limitation of longevity with bioprosthetic valves and an obvious lack of anticoagulation with mechanical prostheses. Moreover, both prostheses cannot create good hemodynamics compared to the native aortic valve.
According to Bazylev V.V. (2019) in patients with severe stenosis of the AV against the background of a small diameter of the fibrous ring, Ozaki pros-thetics demonstrates better echocardiographic parameters compared with indicators in patients after prosthetics AV biological prosthesis with an-nulo-expanding plastic aortic root. In the group of patients after prosthetics of the valves with auto-pericardium according to the Ozaki technique in the medium-term regression is noted hypertrophy, restoration of LV systolic activity and functional class decrease by NYHA heart failure [1, 19]. In patients with severe stenosis of AV on against the background of the small diameter of the fibrous ring, the Ozaki procedure may be the method of choice to avoid prosthetic patient mismatch.
Technique of operation
Surgical technique for reconstruction of the aortic valve has been reported and investigated previously. The preparation of autologous pericardi-
Table 1.
The results of Ozaki procedure according different authors
(S Ф ^ с Patients Results Ozaki procedure
Mean Mean follow-up, month чР 0s чР 0s S * о ■si Ê ет Я rox
Authors (S о 15 s Q. Male Female age, M±m 30-day mortality, 'tn О с ф in о ■fc § Е s ■S 2 ^ ф ф а 2 о LL « aï £ * 1 E-■M О С §1.2 o-o тз (S
Ozaki S. et al. 2011 43 45 70.6±10.5 36.0 0.0 100.0 100.0 12.9±5.8
Ozaki S. et al. 2014 201 203 69.0±12.9 23.7±13.1 1.7 100.0 96.2 13.8±3.7
Ozaki S. et al. 2014 27 59 82.9±2.5 41.4 3.5 100.0 100.0 N/d
Ozaki S. et al. 2014 75 33 47.8 ±11.2 34.2±15.7 0.0 100.0 98.9 12.8±3.1
Ozaki S. et al. 2015 182 234 71.2±12.0 25.2±17.5 1.9 100.0 96.7 14.3±5.
Rosseykin E.V. et al. 2016 20 60.5±13,7 1.0 0.0 100.0 N/d 10.8±3.78
Nguyen D.H. et al. 2017 4 5 44.7 1.0 0.0 100.0 N/d N/d
Ozaki S. et al. 2018 444 406 71.0 53.7±28.2 1.9 100.0 98.2 15.2±6.3
Reuthebuch O. et al. 2018 20 10 66.8±10.6 3.0 3.33 100.0 100.0 14.8±6.21
Mourad F. et al. 2019 33 19 60.0 11.2±4.2 1.9 100.0 90.4 N/d
um began with the cleansing of fat and other excess tissue on the outer surface of the pericardium using a harmonic scalpel. The pericardium was excised at least 7 x 8 cm. Then, the excised pericardium was treated with a 0.6% glutaraldehyde solution with buffer for 10 minutes. The treated pericardium was washed 3 times with saline for 6 minutes. The human pericardium is usually thin near the cranial end and thick caudally near the diaphragm. For the Ozaki procedure, a thinner part of the pericardium is used for small sharp protrusions to make the movement smoother, and a thicker part for large sharp protrusions to withstand more stress. All reconstructive procedures of the aortic valve are performed during cardiac arrest during cardiopulmonary bypass. In short, diseased cusps are carefully excised. In the case of strong calcification along the aortic ring, an ultrasonic surgical suction pump is very useful for removing calcium without damaging the ring tissue. The distance between each commissure is then measured using the originally developed calibration device. The inter-commissory distance is measured using the original calibration apparatus, giving the appropriate tension, similar to the reproduction of the ring during diastole. Correct measurement is vital to complete this operation.
New "cups" with a size corresponding to the measured value are trimmed with an original tem-
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