Immediate outcomes of AVNeo in combination with coronary artery bypass grafting

Aim. To evaluate immediate outcomes of the Ozaki procedure in patients with coronary artery bypass grafting (CABG).

Material and methods. This retrospective study included 416 patients operated on at the Federal Center of Cardiovascular Surgery (Penza). The patients were divided into two groups. The first group included 139 patients who underwent the AVNeo procedure in combination with CABG. The second group included 277 patients who underwent a single AVNeo procedure.

Results. The median time of cardiopulmonary bypass and myocardial ischemia in the AVNeo+CABG group was 146 (134-165) and 115 (104-125), respectively, while in the AVNeo group — 117 (102-136) and 96 (82-109), respectively. The mean aortic valve pressure gradient immediately after surgery in the AVNeo+CABG group was 5,9±3,3, while in the AVNeo group — 6,4±3,1. Mortality in the AVNeo+CABG group was 2,8% (n=4), while in the AVNeo group — 0,3% (n=1). Inhospital survival in the AVNeo+CABG group was 97,1%, while in the AVNeo group — 99,6%. In the AVNeo+CABG group, there were following death causes: perioperative myocardial infarction (n=2), pneumonia (n=1), multiple organ failure (n=1). In the AVNeo group, the cause of the only fatal outcome was multiple organ failure. Only one predictor of inhospital mortality was identified — resternotomy for bleeding. In the case of resternotomy, inhospital death risk increases by 1,3 times for each day of the postoperative period. Cardiopulmonary bypass time, myocardial infarction, and operation duration do not affect mortality. The combination of AVNeo with CABG also does not affect inhospital mortality (p=0,1).

Conclusion. The combination of the AVNeo procedure with CABG is an effective and safe procedure in the immediate period.

1. Ozaki S, Kawase I, Yamashita H, et al. Aortic valve reconstruction using self-developed aortic valve plasty system in aortic valve disease. Interact Cardiovasc Thorac Surg. 2011; 12(4):550-3. doi:10.1510/icvts.2010.253682.

2. Koechlin L, Schurr U, Miazza J, et al. Echocardiographic and Clinical Follow-up After Aortic Valve Neocuspidization Using Autologous Pericardium. World J Surg. 2020;44(9): 3175-81. doi:10.1007/s00268-020-05588-x.

3. Pirola S, Mastroiacovo G, Arlati FG, et al. Single Center Five Years' Experience of Ozaki Procedure: Midterm Follow-up. Ann Thorac Surg. 2021;111(6):1937-43. doi:10.1016/j.athoracsur.2020.08.039.

4. Amabile A, Krane M, Dufendach K, et al. Standardized Aortic Valve Neocuspidization for Treatment of Aortic Valve Diseases. Ann Thorac Surg. 2022;114(4):1108-17. doi:10.1016/j.athoracsur.2022.03.067.

5. Rosseĭkin EV, Bazylev VV, Kobzev EE, et al. Immediate results of bypass grafting of the territory of the right coronary artery using the 'Penza Coronary Technology'. Angiol Sosud Khir. 2019;25(2):137-47. English, Russian. doi:10.33529/angio2019221.

6. Souza D. A new no-touch preparation technique. Scand. J. Thorac. Cardiovasc. Sur. 1996;30:41-4.

7. Nissinen J, Biancari F, Wistbacka JO, et al. Safe time limits of aortic cross-clamping and cardiopulmonary bypass in adult cardiac surgery. Perfusion. 2009;24(5):297-305. doi:10.1177/0267659109354656.

8. Ranucci M, Frigiola A, Menicanti L, et al. Aortic cross-clamp time, new prostheses, and outcome in aortic valve replacement. J Heart Valve Dis. 2012;21(6):732-9.

9. Ozaki S, Kawase I, Yamashita H, et al. Midterm outcomes after aortic valve neocuspidization with glutaraldehyde-treated autologous pericardium. J Thorac Cardiovasc Surg. 2018;155(6):2379-87. doi:10.1016/j.jtcvs.2018.01.087.

10. Iida Y, Fujii S, Akiyama S, Sawa S. Early and mid-term results of isolated aortic valve neocuspidization in patients with aortic stenosis. Gen Thorac Cardiovasc Surg. 2018; 66(11):648-52. doi:10.1007/s11748-018-0976-0.

11. Krane M, Boehm J, Prinzing A, et al. Excellent Hemodynamic Performance After Aortic Valve Neocuspidization Using Autologous Pericardium. Ann Thorac Surg. 2021;111(1): 126-33. doi:10.1016/j.athoracsur.2020.04.108.

12. Khatchatourov G, van Steenberghe M, Goy D, et al. Short-term outcomes of aortic valve neocuspidization for various aortic valve diseases. JTCVS Open. 2021;8:193-202. doi:10.1016/j.xjon.2021.08.027.