Ozaki procedure as a reconstructive strategy in rheumatic multivalvar patients: feasibility and initial outcomes in a low-resource setting.

INTRODUCTION

Selecting the ideal heart valve substitute for young patients with rheumatic heart disease remains challenging, especially in low- and middle-income countries. Both mechanical and biological prostheses have limitations, particularly in multivalvular disease.

MATERIALS AND

METHODS

We conducted a retrospective review of 12 patients with multivalvular rheumatic disease who underwent the Ozaki procedure between January 2022 and December 2024. Clinical, surgical, and early postoperative data were analysed.

RESULTS

Mean age was 25 ± 9 years; 58% were female. All had rheumatic aortic valve disease, 92% with isolated regurgitation, and 8% with mixed lesions. Concomitant mitral disease was present in all: 10 underwent bioprosthetic mitral valve replacement, and two underwent mitral valve repairs. Tricuspid repair was performed in two patients (17%). The Ozaki procedure was completed in all patients without intraoperative need for conversion to prosthetic valve replacement. No deaths were observed. Two patients (16.7%) required re-exploration for bleeding, and one (8.3%) underwent surgical revision due to a paraneocuspid leak corrected in the same surgical procedure. Another patient developed early neovalve dysfunction due to active rheumatic carditis, which resolved with medical therapy. Early postoperative echocardiography showed trivial or no aortic regurgitation in all patients. Mean hospital stay was 27 ± 10 days.

CONCLUSION

The Ozaki procedure is a feasible and safe option for selected young patients with multivalvular rheumatic disease, offering advantages in resource-limited settings.