Prevalence and Clinical Significance of Cusp Thickening and Reduced Cusp Motion After the Ozaki Procedure

As with hypoattenuated leaflet thickening observed early after transcatheter aortic valve replacement, early cusp thickening and reduced cusp motion after the Ozaki procedure sometimes occur.

From 2014 to 2016, 184 patients underwent Ozaki procedures at Toho University Ohashi Medical Center (Tokyo, Japan). Of these patients, 143 had adequate quality transesophageal echocardiography (TEE) within 2 weeks postoperatively. Cusp thickening was defined as new hyperechoic meniscal appearance compared with the intraoperative TEE. The study investigated frequency of cusp thickening and reduced cusp motion and their effect on longitudinal valve performance and clinical outcomes during the subsequent median 5.9-year follow-up.

Of the 143 patients, 32 (22%) experienced early cusp thickening, and 57 (40%) had reduced cusp motion. Neither condition resulted in escalation of antithrombotic therapy. All patients with cusp thickening had reduced cusp motion. Smaller aortic sinus size and higher low-density lipoprotein cholesterol levels were associated with the occurrence of cusp thickening and cusp size difference with the occurrence of reduced cusp motion. There was no difference in risk of all-cause mortality or aortic valve reoperation between patients with and without cusp thickening (P = .44 for both), and cusp thickening was not associated with higher mean gradients (P = .39).

Without escalation of antithrombotic treatment, midterm outcomes of patients with early cusp thickening or reduced cusp motion were comparable to those without. This phenomenon is frequent, and although it appears benign, concern remains and requires further studies.