Mid-term valve performance and durability of the Ozaki procedure in patients on chronic dialysis

Objective To compare the hemodynamic performance and durability of the Ozaki procedure in patients with end-stage renal disease on chronic dialysis between patients not on dialysis and patients on dialysis undergoing bioprosthetic aortic valve replacement (bAVR). Methods Between January 1, 2007, and May 1, 2021, 155 adults on dialysis underwent the Ozaki procedure at Toho University Ohashi Medical Center. Mean aortic valve gradient, aortic regurgitation grade, and freedom from reoperation were compared between 121 propensity score–matched patients not on dialysis undergoing the Ozaki procedure and 125 age-matched patients on dialysis undergoing valve replacement with a stented bovine pericardial bioprosthesis at Cleveland Clinic between January 1, 2001, and January 1, 2022. Results Five years after the Ozaki procedure, matched patients on dialysis were less likely to have moderate/severe regurgitation (1.7%) compared to those not on dialysis (4.1%). In the 2 groups, mean aortic gradient was 7 mmHg and 9 mm Hg, respectively ( P = .06), and freedom from aortic valve reoperation was 91% and 96%, respectively ( P = .4). Age-matched patients on dialysis undergoing the Ozaki procedure and those undergoing bAVR had a mean gradient of 9 mm Hg and 13 mm Hg, respectively, at 6 months ( P < .001) and 11 mm Hg and 14 mm Hg at 5 years ( P < .001). At 5 years, the prevalence of moderate/severe regurgitation was 1.3% and 2.0%, and freedom from reoperation was 91% and 96% ( P = .4). Conclusions In patients on chronic dialysis undergoing the Ozaki procedure, hemodynamics and durability are similar compared with those not on dialysis, and mean gradients are lower compared with those receiving a bioprosthesis. These findings support use of the Ozaki procedure in patients on dialysis requiring aortic valve replacement.