Early Hemodynamic and Clinical Outcomes of Aortic Valve Neocuspidization for Severe Aortic Stenosis: A Single-Center Experience

Abstract

Objective: Aortic valve neocuspidization using autologous pericardium is a reconstructive option for aortic valve disease. We evaluated the early hemodynamic and clinical outcomes of the Ozaki procedure in a single-center cohort.

Methods: This retrospective study included 31 consecutive patients with severe aortic stenosis who underwent aortic valve neocuspidization between January 2023 and June 2025. Pre-operative and 6-month echocardiographic findings were compared in 30 patients with paired data. Clinical outcomes were assessed through at least 12 months of follow-up among surviving patients.

Results: Median age was 65.0 years, and seven patients (22.6%) underwent a concomitant cardiac procedure. The median mean transvalvular gradient decreased from 50.5 mmHg preoperatively to 9.0 mmHg at 6 months (p<0.001). The maximum gradient decreased from 83.0 to 18.0 mmHg, and peak aortic jet velocity decreased
from 4.60 to 1.85 m/s (both p<0.001). At 6 months, aortic regurgitation was absent in 16 patients (53.3%), mild in 12 (40.0%), and moderate in two (6.7%); none had severe regurgitation. One patient (3.2%) died during the index hospitalization. Another developed infective endocarditis with acute severe aortic regurgitation at 9 months and subsequently died. Overall 1-year survival was 93.5%.

Conclusion: Aortic valve neocuspidization was associated with low transvalvular gradients and generally favorable valve competence at 6 months. The fatal endocarditis event underscores the need for continued surveillance. Larger studies with longer follow-up are needed to assess durability.

Cite This Article: Özçelik S, Erden Güven B. Early Hemodynamic and Clinical Outcomes of Aortic Valve Neocuspidization for Severe Aortic Stenosis: A Single-Center Experience. Koşuyolu Heart J 2026;29(3):212–218