Pulmonary valve neo-reconstruction using the Ozaki technique in an adapted Ross procedure: case report

TL;DR

This case report describes a modified Ross procedure using a new pulmonary valve technique to treat aortic valve disease without needing homografts.

Contribution

The paper introduces a neo-reconstruction technique for the pulmonary valve in the Ross procedure using autologous pericardium, avoiding homograft dependency.

Findings

The modified Ross procedure with Ozaki's neo-cuspidalization resulted in no aortic valve regurgitation and low pressure gradients.

The new pulmonary valve showed minimal regurgitation and acceptable function four months post-surgery.

The technique is viable for centers without access to pulmonary homografts.

Abstract

Aortic valve damage is the most common valvular heart disease in developed countries. The Ross procedure is an alternative to the aortic valve replacement with a prosthesis, providing a longer survival without reoperation and without the need for anticoagulation therapy. The unavailability of homografts for the pulmonary valve replacement is one of the limiting factors for a more common utilization of this therapeutic method.

This case report presents a 35-year-old Caucasian male with a bicuspid aortic valve and severe aortic regurgitation. The patient underwent the Ross procedure with the stabilization of the aortic ring and sinotubular junction. A tubular prosthesis was created from the bovine pericardium, into which three neo-cusp valves were fashioned from autologous pericardium. The new pulmonary conduit was sutured distally to the distal pulmonary trunk and proximally to the right ventricular outflow tract. Four months post-operatively, the follow-up echocardiographic examination documented that the valve in the aortic position had no regurgitation, a maximum velocity of 1.25 m/s, and a peak gradient of 6.25 mmHg. The valve in the pulmonary position showed a trace regurgitation and mean pressure gradient of 13 mmHg.

The combination of the modified Ross procedure with neo-cuspidalization according to Ozaki for a new pulmonary valve thus offers hope for an extended survival without reoperation in paediatric and non-elderly adult patients with an aortic valve dysfunction. This technique is additionally applicable by cardiac surgery centres without access to pulmonary homografts.

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