Objectives Using bovine pericardium allows the Ozaki procedure to be performed minimally invasively or in patients with abnormal pericardium, but its comparative effectiveness has not been tested. We compare hemodynamic performance and outcomes of the Ozaki procedure performed with bovine pericardium to (1) the original Ozaki procedure performed with autologous pericardium and (2) aortic valve replacement with a stented bovine pericardial bioprosthesis. Methods From 1/1/2007–5/1/2021, 48 patients underwent the Ozaki procedure with bovine pericardium at Toho University Ohashi Medical Center. Mean aortic valve gradient, aortic regurgitation grade, and freedom from reoperation were compared with those of 43 propensity-matched patients undergoing the Ozaki procedure with autologous pericardium and with 48 propensity-matched patients undergoing valve replacement with a bovine pericardial bioprosthesis at Cleveland Clinic from 1/1/2011–1/1/2022. Results In matched Ozaki patients receiving bovine versus autologous pericardium, mean gradients at 5 years were 11 versus 7.0 mmHg, respectively (P=.0013), moderate/severe regurgitation was 0.0% versus 2.3%, and freedom from aortic valve reoperation was 100% for both. Comparing matched Ozaki patients receiving bovine pericardium with patients undergoing valve replacement, mean gradients at 5 years were 11 versus 11 mmHg, respectively (P=.78), moderate/severe regurgitation was 0.0% versus 2.0%, and freedom from reoperation was 100% for both. Conclusions Use of bovine pericardium for the Ozaki procedure demonstrated slightly higher mean gradients compared with autologous pericardium, but outcomes are similar. These findings support continued use of the Ozaki procedure with bovine pericardium, particularly in cases with inadequate native pericardium and for minimally invasive approaches.
Objective The Ross procedure offers superior hemodynamics and growth potential for patients with unrepairable aortic valve disease, but pulmonary autograft dilation and progressive neoaortic valve regurgitation remain key limitations. Complete autograft reinforcement with Dacron has been proposed to enhance structural stability and prevent dilation. However, concerns persist regarding potential autograft distortion, impaired leaflet coaptation, and increased valve regurgitation. This systematic review and meta-analysis compares clinical outcomes of fully Dacron-supported versus unsupported or partially supported autografts in the Ross procedure. Methods A comprehensive literature search of PubMed, Web of Science, Cochrane, and Scopus databases was conducted from inception through March 30, 2026. Five retrospective comparative cohort studies including a total of 526 patients met inclusion criteria. Outcomes evaluated were early mortality (≤30 days), overall survival, freedom from autograft reoperation, and incidence of moderate or greater neoaortic valve regurgitation. Pooled risk ratios (RRs) with 95% CIs were calculated using random-effects meta-analysis. Results No significant differences were observed between fully supported and unsupported/partially supported groups for early mortality (RR, 2.52; 95% CI, 0.28-22.51; P = .41, I2 = 0%), overall survival (RR, 0.99; 95% CI, 0.97-1.00], P = .14, I2 = 0%), freedom from autograft reoperation (RR, 0.90; 95% CI, 0.76-1.07], P = .25, I2 = 79.1%), or incidence of moderate or greater neoaortic valve regurgitation (RR, 2.00; 95% CI, 0.39-10.25; P = .41, I2 = 73.5%). Conclusions Complete Dacron reinforcement of the pulmonary autograft does not increase the risk of neoaortic valve regurgitation or adversely affect clinical outcomes compared with unsupported or partially supported autografts. This technique offers a viable strategy to improve autograft durability and may enable the Ross procedure's application in patients previously deemed suboptimal candidates. Surgical technique should be tailored to individual patient profiles and institutional expertise, rather than standardized adoption of one technique.
Objective To report the mid-term outcomes of the Lugones procedure (in situ pericardial rerouting technique) and its variants for scimitar syndrome repair. Methods Multicenter retrospective descriptive study of patients undergoing scimitar syndrome repair with the Lugones procedure. Three variants were used: original, variant A with atrial septum repositioning, and variant B with an interatrial pericardial flap. Primary endpoints were survival, freedom from reoperation, and freedom from pulmonary venous obstruction. Follow-up was based on clinical assessment and serial echocardiography; CT scan, MRI/4D-flow MRI, or cardiac catheterization were obtained when echocardiographic assessment was limited, clinical or imaging findings were equivocal, or complementary anatomic/hemodynamic information was sought. Results Thirty-eight patients from 11 institutions were included (median age 5 years; range 0.7–43). Preoperative scimitar vein stenosis was present in ∼29%; aortopulmonary collaterals were embolized preoperatively in 24 patients (63%). The original procedure was performed in 28 cases, variant A in 5, and variant B in 5. In-hospital mortality was 0%. Early complications were uncommon (1 postoperative pulmonary venous pathway obstruction due to extrinsic compression; 1 transient diaphragmatic dysfunction). Mean follow-up was 74 months (maximum 13.5 years), with no late deaths, reoperations, recurrent obstruction, or additional late pulmonary venous pathway obstruction. CT scans consistently demonstrated wide reconstructed pathways; 4D-flow MRIs showed physiological pulmonary venous flow patterns after repair. Conclusions The Lugones procedure yielded excellent mid-term outcomes with no deaths or reoperations and a very low incidence of postoperative pulmonary venous obstruction.
