Just as a mechanic who has to repair a car obtains an optimal result with the original parts, so the heart surgeon should have the patient’s tissues available to carry out the best repairs of the heart valves. This approach, mixed with ancient Japanese art that has become innovation, is the basis of the degenerate aortic valve replacement technique that sees the specialist become a sort of “artist”, as happens for the creation of precious origami. To develop this method was Shigeyuki Ozaki. Now, thanks also to Italian cardiac surgery, we know that the approach is not only useful and effective, but also safe and capable of giving results at a distance. The results of the patients treated at the Monzino Cardiology Center, published in Annals of Thoracic Surgery. Monzino’s experience, the second largest at international level, demonstrated zero intraoperative mortality and the absence of major adverse events in 97% of cases. Five years after the operation, no patient had recurrence of severe valve vice and none had to be reoperated. But that’s not enough. Monzino surgeons not only use the Ozaki technique but, as confirmed by the data just published in Journal of Cardiovascular Computed Tomography, are able to know in detail the real anatomy of the pathological aortic valve and the size of the new flaps they will create.
One of the major innovations in cardiac surgery
“The Ozaki technique is one of the major innovations in cardiac surgery of the last ten years and at Monzino we were the first to experiment and develop it in Europe – he explains Gianluca Polvani, Director of the Cardiovascular Surgery Department of the Monzino Cardiology Center and Professor of Cardiac Surgery at the University of Milan. The data today prove us right: reconstruction with patient tissue achieves the same results as implantation of a prosthesis in terms of effectiveness, with indisputable advantages for patients. The first major advantage is that the reconstructed valve does not run the risk of rejection and allows the patient to avoid having to take anticoagulant therapy after surgery. Furthermore, the exclusive use of tissue with its own DNA promises a duration of the neovalve much higher than that of traditional biological prostheses, based on animal tissue. We could define it as an autologous biological valve replacement “.
In fact, thanks to this technique, the surgeon creates, starting from the pericardium, the membrane that surrounds and protects the heart, three new aortic flaps which, once implanted on the patient’s aortic ring, behave exactly like the original flaps. During the surgery, a segment of the pericardium is taken from the patient and, with a special template, three new flaps are obtained, measuring them with extreme precision on the morphology of the patient’s aortic valve. The new valve flaps are then “sewn” onto the aortic annulus to create a new valve and behave like the original ones.
Heart valves, when, how and why to intervene
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The procedure developed over ten years ago by Shigeyuki Ozaki, a Japanese heart surgeon at the University of Tokyo, has already been the basis of over 6000 operations worldwide. But from that first intuition, of course, the research went on. “The latest news regarding the Ozaki technique – concludes Polvani – is the” Promoter “procedure (PRerative Ozaki Technique Measures On Tridimensional Engineered Root), the results of which have just appeared on Journal of Cardiovascular Computed Tomography. The new method was developed by the Monzino team to reduce the times of asystole, that is the period of the intervention during which the patient’s heart remains stationary and extracorporeal circulation is therefore necessary. “How? Building before the intervention a 3-D model of the valve based on the TAC data, to then proceed working on the indications offered by this “copy”, gaining time during the intervention.
Heart, when and how to use non-invasive therapies
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