Procedure. The Ozaki procedure is a versatile approach to aortic (and increasingly, pulmonary) valve plasty or replacement. In this procedure, one or more diseased leaflets are replaced with either pericardium or Goretex that is fashioned according to a sizer and corresponding template. In some cases, the entire native valve is excised. If needed, the aortic root may be enlarged using a Konno or Manougian procedure. Sizers are then applied as shown (left middle), taking care to orient the commissures such that the coronary artery lies in the middle of the neo-cusp. Suture markings are placed according to the template (purple dots) and the valve is sutured in place. Additional pledgeted fortification sutures are placed to reinforce the commissures.
Postoperative considerations. In most cases, acute postoperative valve function is excellent and there is infrequently valve stenosis. In some cases, there is valvar regurgitation that must be closely monitored. Anticoagulation in the early postoperative period is focused upon the prevention of future valve dysfunction, which is putatively related to early thrombus formation.