NYP/Morgan Stanley Children’s Hospital, a national leader in neonatal cardiac surgery, is known for the treatment of hypoplastic left heart syndrome, transposition of the great arteries, interrupted aortic arch and tetralogy of Fallot.
In May 2018, Damien LaPar, MD, and Emile Bacha, MD, expanded the options for children needing aortic valve reconstruction by performing that repair with the Ozaki technique.
“This is an operation for children few centers can do,” says Dr. LaPar, a pediatric cardiac surgeon who trained at Harvard Medical School and Boston Children’s Hospital where the Ozaki method has been increasingly performed over the past few years. “We are now offering this as an alternative to the Ross procedure or prosthetic valve replacement. For certain patients, this may be a better option.”
The Ozaki technique involves resection of the native aortic valve leaflets followed by the sewing of new leaflets into the native aortic valve annulus and aortic root. “We can do this using the native pericardium when available or bovine pericardium. Our preference is using the patient’s own tissue,” says Dr. LaPar.
How does this novel operation compare to prosthetic aortic valve replacement and the Ross procedure? “The Ozaki technique preserves normal contributions of the aortic root to left-sided cardiac function, and the reconstruction has the potential to grow with the child,” says Dr. LaPar. “In addition, it preserves the right ventricular outflow tract and pulmonary valve, avoiding future surgical intervention on the pulmonary valve.”
The Ross operation remains the gold standard surgical therapy for aortic valve dysfunction in the pediatric and young adult population. During this procedure, the aortic valve is replaced with the patient’s pulmonary valve. This also requires replacement of the right ventricular outflow tract. The Ross operation thus affects two different semilunar valves. “With the Ozaki technique, we only address the aortic valve,” says Dr. LaPar. “We still have the option for future Ozaki reconstruction, prosthetic valve replacement, or conversion to a Ross at a later point, if needed.”
Drs. Bacha and LaPar recently completed Ozaki reconstructions on two pediatric patients with good results. Yoshifumi Naka, MD, PhD, has also performed several Ozaki operations on adults at NYP/Columbia.
“We are leaders in complex adult congenital surgery as well, and the field is rapidly expanding,” says Dr. LaPar. “We’re seeing patients we operated on 10 to 15 years ago who need follow up procedures.”
The most common adult congenital operations are conduit revisions, pulmonary valve replacements, repair of Ebstein’s anomaly of the tricuspid valve, and surgical management of aortic roots that have dilated since neonatal and infant surgeries.” Learn more about Pediatric Cardiac Surgery at Morgan Stanley Children’s Hospital and the Adult Congenital Heart Center at NYP/Columbia.
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