Three-year results of Ozaki surgery in patients aged >65 years: a multicentre study

Background. Currently, aortic valve stenosis is the most common disease of the native valve, which affects 5% of the elderly population. In symptomatic patients, aortic valve replacement is the 'gold standard'. For patients aged >65 years, the use of biological prostheses is recommended. The Ozaki operation is an alternative to bioprostheses. Aim. The aim of this study was to evaluate the immediate and 3-year results of Ozaki surgery in patients aged >65 years. Methods. This was a prospective multicentre study conducted on 107 patients aged >65 years, who underwent the Ozaki procedure at three centres during 2016-2019. There were 46 (43%) men. The median age of the patients was 69 [67-74] years. Severe aortic stenosis was the major cause of aortic valve dysfunction (106 patients [99.1%]). Chronic heart failure III-IV functional class according to NYHA was diagnosed in 47 (43.9%) patients. The following complications were also registered: atrial fibrillation in 30 (28%) patients, a history of diabetes mellitus in 16 (15%) patients, chronic obstructive pulmonary disease in 14 (13.1%) patients and coronary artery disease in 42 (39.2%) patients. Bicuspid aortic valve was detected in 36 (34.6%) patients. There were 72 (67.2%) patients with a small annulus (2. None of the patients had moderate and severe aortic regurgitation. The 3-year overall survival and freedom from reoperation were 88.6% and 97%, respectively. Conclusion. The Ozaki operation in patients aged >65 years has good immediate results, with a hospital mortality rate of 1.9%, excellent haemodynamic parameters with an average pressure gradient across the aortic valve of 4 [3-6] mmHg and a valve opening area of 2.6 [2.3-2.9] cm2. The 3-year overall survival and freedom from reoperation were 88.6% and 97%, respectively. Further monitoring of these patients is required to evaluate long-term results, and there is also a need for randomised clinical trials comparing Ozaki operation with bioprostheses.