Hemodynamics and structural mechanics of the aortic valve after Ozaki procedure: a systematic review

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Abstract Objective. The Ozaki procedure utilizes glutaraldehyde-treated autologous pericardium for aortic valve (AV) neocuspidization (AVNeo), offering hemodynamic performance comparable to native valves without long-term anticoagulation. Approach. This review synthesizes evidence from 39 studies, up to September 2024, to evaluate post-procedural AV biomechanics. Medical imaging modalities (echocardiography, magnetic resonance image, and computed tomography) and numerical simulations (finite element model, computational fluid dynamics, and fluid-structure interaction (FSI)) are analyzed for assessing hemodynamic and structural parameters for postoperative management and surgical optimization. Main results. Imaging modalities excel in real-time morphology evaluation, while simulations reveal flow and stress distributions inaccessible via clinical tools. Current limitations include imaging resolution, geometry reconstruction and material property model. Future researches emphasize integrating patient-specific imaging data with advanced FSI to enhance valve durability predictions and refine procedural guidelines. Significance. This work serves as a link between clinical observations and computational insights, guiding personalized treatment strategies for AVNeo patients.

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