Underarm (Minimally Invasive) Ozaki Procedure
The Ozaki procedure can be performed using a minimally invasive approach, meaning that the sternum is not cut and the procedure is performed through the underarm. The Ozaki procedure with a small incision in the armpit was first performed worldwide and in Turkey by Prof. Dr. Ahmet Yavuz Balcı in 2021. Since then, the number of minimally invasive armpit Ozaki cases has been steadily increasing. The details of this procedure can be summarized as follows:
Feasibility
Although the minimally invasive application of the Ozaki procedure depends on the patient’s general condition and the characteristics of the aortic valve disease, the armpit Ozaki procedure is a suitable method for many people with aortic valve stenosis and aortic valve insufficiency.
Indications
The minimally invasive Ozaki procedure is typically performed in patients with aortic valve stenosis, but many patients with aortic valve insufficiency are also suitable candidates for the Ozaki method.
Technical Challenges
Minimally invasive Ozaki surgery is directly related to the experience of the surgical team. Technical and application difficulties for surgeons without experience in axillary heart surgery are the reason why this procedure is not performed by many surgeons worldwide. The removal of the heart valve during the procedure is also one of the technical challenges of axillary Ozaki surgery.
Imaging and Access Difficulties
Minimally invasive surgery may have more limited imaging and access capabilities compared to traditional open heart surgery. Therefore, if the Ozaki procedure is to be performed with minimal incisions, it should be performed by surgeons with minimally invasive experience.
Patient Selection
Patients suitable for minimally invasive Ozaki surgery are typically those with aortic stenosis and aortic insufficiency caused by a tricuspid aortic valve. Patients with bicuspid (two-leaflet) or unicuspid (single-leaflet) aortic valve diseases are also suitable candidates for Ozaki surgery, which is performed via a small incision in the armpit.
Complication Risks
The risk of complications developing in minimally invasive surgery is lower than in open heart surgery. Additionally, recovery and return to social life are faster after the procedure.
Patient Anatomical Structure
While severe chest bone deformities may prevent open-heart surgery, there are no anatomical contraindications for the minimally invasive Ozaki procedure performed through the armpit. However, relative contraindications may exist in patients with severe aortic or peripheral vascular disease.
Surgical Team Experience
Minimally invasive surgery can affect the success rate depending on the experience of the surgical team. Having a surgical team with sufficient experience in minimally invasive surgery can ensure the successful performance of the surgery. It is important to remember that surgical experience is a skill that comes with performing a large number of cases.
Recovery Process
The recovery process for minimally invasive Ozaki surgery is generally shorter than that of traditional open heart surgery. Patients may experience less pain and faster recovery after surgery. Patients can return to their social lives much faster than with open surgery.
Results and Expectations
Minimally invasive heart surgery is a trending topic among surgeons and patients worldwide, and like in all fields, minimally invasive techniques in heart surgery—including minimal incisions, minimal blood use, minimal hospital stays, minimal disruption to social life, and rapid return to pre-surgery performance—will continue to be a desired and sought-after option.
In conclusion, the minimally invasive application of the Ozaki procedure can be performed in almost all cases of aortic valve stenosis and aortic valve insufficiency. There may be a few exceptions, and it is advisable to consult with a Cardiovascular Surgeon specializing in minimally invasive axillary aortic valve and aortic vessel surgery.