In the past, aortic valves were mostly replaced but recently there are variety of options for aortic valve reconstruction. This study aimed to determine echocardiographic haemodynamic parameters and survival of the children with aortic valve disease who underwent Ozaki procedure at our Institute for the past 4 years. Out of 16 children who underwent surgery due to aortic valve disease, ten had aortic valve reconstruction by Ozaki technique. Among them only one child died.

In this study, all the children had either none or trivial residual valve regurgitation from severe form preoperatively. This is because, aortic valve reconstruction using the Ozaki technique makes the coaptation zone longer than the native valve, hence reducing postoperative aortic insufficiency. Wiggins and colleagues echoed the above outcomes by reporting 100% freedom from moderate to severe AR post Ozaki procedure during follow-up [10]. Additionally, none of our study participants had a reported redo surgery throughout the follow-up period. Similar findings were also reported in India and Japan [4, 8].

Among those who underwent aortic valve reconstruction, aortic valve pathology was mostly a result of rheumatic heart disease. This is due to the fact that rheumatic heart disease is much prevalent in resource limited countries including Tanzania as reported by Allen and his colleagues [2]. Conversely, the father of the Ozaki technique reported degenerative calcification in the majority of his patients which was due to comparative age difference [8].

Despite the two patients who were lost to follow up, seven children were alive during the follow-up period. Only one child died at a peripheral hospital a year later, however, the exact cause of death was uncertain. The above can be due to few reported valve-related complications including endocarditis following reconstructive surgery as published by Ozaki and his colleagues as well as Aicher et al. [8, 12, 13]. Apart from endocarditis, valve calcification has been reported though different material other than autologous pericardium were used [10, 14].

In addition to low reoperation rates [8], there is no need for lifelong anticoagulation after Ozaki procedure which resonates well with economic conditions of our patients. Most of our patients have financial constraints and availability of warfarin in our country is only promising at hospital level, hence, this procedure does not only avoid complications following long-term use but is also cost-effective [8, 12]. It reduces the financial burden generated by direct and indirect healthcare costs including transport to and from the hospital especially those in remote areas. On the other hand, size mismatch between protheses and our growing children make early-redo surgical interventions unavoidable.

The limitations of our current study are attributed to its retrospective nature, and it is from a single institution. Additionally, a small number of children underwent this procedure. This is due to the fact that aortic valve in children is not as commonly affected as mitral valve in view of RHD though children are presenting at advance stage requiring surgical intervention.