Flattening the Curve

The Ozaki procedure (aortic valve neocuspidization) was first reported by Dr. Shigeyuki in 2011. This involves the recreation of aortic leaflets using autologous pericardium.1Ozaki S. Kawase I. Yamashita H. et al.A total 404 cases reconstruction with glutaraldehyde-treated pericardium.J Thorac Cardiovasc Surg. 2014; 147: 301-306Abstract Full Text PDF PubMed Scopus (153) Google Scholar proposed benefit this longer coaptation length and preserved annular mobility leading to a larger orifice area. Midterm results have shown durable outcomes. However, its adaptation has been slow.2Pirola Mastroiacovo G. Arlati F. al.Single center 5-years’ experience procedure: mid-term follow-up.Ann 2020; (pii: S0003-4975(20)31730-6)Google One reasons is complex nature procedure, which pericardial harvesting, resecting creating shape each leaflet, suturing annulus. To overcome complexity, dedicated tool developed, includes sizers cusp template detailed guide leaflet suturing. In edition journal, Patel colleagues presented standardized approach adopted at Cleveland Clinic minimize learning curve procedure. Their strategy included limiting operators 2 surgeons, tools standardize most importantly, visiting observe surgery installing wet lab practice. Notably, their 20 cases, there no major perioperative morbidity or mortality, while cardiopulmonary bypass cross-clamp times steadily decreased ​minutes. Both time plateaued after cases. These steps proved quite effective given minimum early relatively rapid decrease times. authors emphasize that keys minimizing were observation coaching from an expert, Dr Ozaki, simulation lab. are be commended, as for every we do, especially procedures. For context, other examples challenging cardiac operations can significant field include valve-sparing root replacement minimally invasive mitral repair. Beckmann colleagues3Beckmann E. Martens A. Krueger al.Aortic (David): impact on outcome.Interact 30: 754-761Crossref (11) described replacement. They found less surgeon risk factor valve-related reoperation-free survival. Interestingly, needed start seeing reoperation. reduction both seen even 40 Other series indicated continued up 7 years terms reoperations.4Chirichilli Scaffa R. Irace F.G. al.Twenty-year reimplantation Valsalva graft.Eur J Cardio 2023; 63ezac591Crossref (0) surgery, Vo al.5Vo A.T. Nguyen D.H. Van Hoang al.Learning surgery: single-center experience.J Cardiothorac 2019; 14: 213Crossref (19) repair requiring least 90 acceptable technical complication rate. By taking adequate strategies, group able diminish significantly, considering complexity As highlighted article, vital curve. advance, will key improving outcomes our field, specifically do. example, congenital another segment junior surgeons trainees area where come under increasing scrutiny. Hospital Sick Children Toronto published Hands-On Surgical Training program. others outside institutions participate monthly three-dimensional (3D)-printed models specific lesions. program hands-on training anatomy repairs further facilitates expert surgeons.6Van Arsdell G.S. Hussein N. Yoo S.J. Three-dimensional printing surgery-Now future.J 160: 515-519Abstract (15) All participants it help improve surgical skills.7Yoo Spray T. Austin E.H. Yun T.J. van Hands-on heart 3-dimensional print models.J 2017; 153: 1530-1540Abstract (129) 3D becomes easier streamline, adult procedures make steep when they step into operating room. With advancement printing, critical leverage these study highlights all inevitably new operation, master surgeon. There some concern about regurgitation general population needs investigation. manuscript proves preparation flatten Most dogmas also applicable nonsurgical numerous upcoming technologies structural disease, such transcatheter mitral/tricuspid repair/replacement. often done team, including interventional cardiologists and/or surgeons. embrace innovations heart, specialty need constantly think how maintaining quality authors' provides roadmap us try emulate. funding report.