Incidence of Infective Endocarditis after AV: Neocuspidization Using Autologous Pericardium (Ozaki Procedure)

Objectives: Recently, aortic valve neocuspidization (AVNeo) using autologous pericardium was introduced and showed excellent early and midterm hemodynamic results in terms of pressure gradients and effective orifice area (EOA). Nevertheless, mid- and long-term data regarding valve durability are lacking. Recent data suggest that infective endocarditis might be the most important trigger for reoperation.

Methods: From 11/2016 to 08/2020, a total of 152 patients with a mean age of 54.5 years ± 16 years underwent AVNeo at our institution. None of these patients had presented with acute infective endocarditis at primary surgery. We analyzed hemodynamic performance and clinical outcome with a special focus on the incidence of infective endocarditis during follow-up. For hemodynamic evaluation transthoracic echo (TTE) was performed prior to the operation, at discharge and annually after surgery.

Result: Mean follow-up time was 1.8 years ± 1.1 (range from 3 days to 3.8 years) with a cumulative follow-up of 342.5 patient-years. At discharge, mean pressure gradient (MPG) was 8.5 ± 3.7 mm Hg, and remained stable at 1-, 2, and 3-year follow-up with MPG being 8.8 ± 3.9 mm Hg, 9.7 ± 4.4 mm Hg, and 9.0 ± 4.4 mm Hg, respectively. Furthermore, effective orifice area (EOA) was preserved over time with a mean EOA of 2.3 ± 0.8 cm², 2.2 ± 0.8 cm², 2.0 ± 0.7 cm² at 1-, 2-, and 3 years of follow-up, respectively, and 2.1 ± 0.6 cm² at discharge. Overall, eight patients underwent reoperation resulting in a freedom from reoperation of 94.7%. Main indication for reoperation was infective endocarditis in five of eight cases. Linearized event rate for endocarditis was 1.46% per patient year during follow-up. Potential reasons and time course of infective endocarditis are given in Table 1.

Patient no.	Time after surgery	Background and possible foci
1	43 days	Pericardial function before surgery
2	99 days	Long-term steroid therapy
3	1.72 years	Unclear focus
4	2.34 years	Treatment for newly diagnosed multiple myeloma
5	2.82 years	Hospitalization for carotid surgery

Conclusion: AVNeo showed preserved excellent hemodynamic outcomes in terms of MPG and EOA. Main reason for reoperation is infective endocarditis during midterm follow-up.

Publication History

Article published online:
19 February 2021