Minimally invasive Ozaki technique.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Biomaterials in Medicine

Background:

• Traditional aortic valve replacement with mechanical or biological grafts necessitates anticoagulation and carries risks of complications.
• The Ozaki operation, utilizing autologous pericardium for aortic valve repair, offers promising hemodynamic characteristics and reduced re-operation rates.
• Minimally invasive cardiac surgery, including upper partial sternotomy, is increasingly adopted for aortic valve procedures due to cosmetic and potential outcome benefits.

Purpose of the Study:

• To compare the clinical outcomes of the minimally invasive Ozaki technique versus the traditional full sternotomy approach for aortic valve repair.
• To evaluate the safety and efficacy of the Ozaki procedure performed via minimally invasive versus conventional sternotomy.
• To assess short-term adverse events and procedural parameters in patients undergoing aortic valve repair with the Ozaki technique through different surgical accesses.

Main Methods:

• A retrospective study comparing the minimally invasive Ozaki technique (Ozaki Mini Group, n=30) with the full sternotomy approach (Ozaki Full Group, n=112).
• Computer-assisted propensity score matching was employed to create comparable groups of 30 patients each.
• Primary outcomes included 30-day all-cause mortality and major adverse cardiac events (myocardial infarction, stroke); secondary outcomes involved operative duration, ischemia time, blood loss, and complications.

Main Results:

• Propensity score matching resulted in two comparable groups of 30 patients each.
• The study aimed to compare 30-day mortality, major adverse cardiac events, and other perioperative outcomes between the minimally invasive and full sternotomy Ozaki procedures.
• Detailed analysis of specific complications such as new-onset atrial fibrillation, renal failure, and mediastinitis was conducted.

Conclusions:

• The minimally invasive Ozaki technique demonstrates comparable safety and efficacy to the full sternotomy approach for aortic valve repair.
• Both surgical approaches provide excellent hemodynamic function and a low frequency of re-do operations.
• Minimally invasive aortic valve surgery using the Ozaki technique is a viable alternative to conventional sternotomy, offering potential benefits in specific patient populations.