Subclinical leaflet thrombosis in Ozaki procedure

Interdiscip Cardiovasc Thorac Surg. 2025 Mar 5;40(3):ivaf051. doi: 10.1093/icvts/ivaf051.

Abstract

Aortic valve reconstruction with autologous glutaraldehyde-fixed pericardium (Ozaki procedure) represents an alternative to conventional prosthetic valve replacement, allowing excellent haemodynamic outcomes. We report two cases of subclinical leaflet thrombosis (SLT) at 12 and 23 months of follow-up. Anticoagulation was initiated, and later echocardiography showed haemodynamic and mobility improvement. SLT is well documented for bioprosthetic valve. To our knowledge, this is the first report for Ozaki procedure in an adult population. Glutaraldehyde is known for cytotoxicity, and partial endothelialization can be responsible for thrombosis, creating favourable conditions for later endocarditis and degeneration. Anticoagulation should be recommended postoperatively for the first 3 months with control at 6 months. Finally, alternative treatment to glutaraldehyde should be investigated.

Keywords: Ozaki procedure; anticoagulation; endothelialization; glutaraldehyde; subclinical leaflet thrombosis.

Publication types

  • Case Reports

MeSH terms

  • Anticoagulants / therapeutic use
  • Aortic Valve* / diagnostic imaging
  • Aortic Valve* / physiopathology
  • Aortic Valve* / surgery
  • Bioprosthesis*
  • Glutaral* / adverse effects
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis Implantation* / instrumentation
  • Heart Valve Prosthesis Implantation* / methods
  • Heart Valve Prosthesis*
  • Humans
  • Pericardium* / transplantation
  • Thrombosis* / diagnosis
  • Thrombosis* / diagnostic imaging
  • Thrombosis* / drug therapy
  • Thrombosis* / etiology
  • Thrombosis* / physiopathology
  • Transplantation, Autologous
  • Treatment Outcome

Substances

  • Anticoagulants
  • Glutaral