Long-term results after aortic valve-sparing operation (David I)

Shrestha, Malakh; Baraki, Hassina; Maeding, Ilona; Fitzner, Sebastian; Sarikouch, Samir; Khaladj, Nawid; Hagl, Christian; Haverich, Axel

doi:10.1016/j.ejcts.2011.04.012

Cited by 66 publications

(95 citation statements)

References 25 publications

(32 reference statements)

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“…Besides these technical challenges, the lack of neosinuses of Valsava and of a neo-STJ has theoretical haemodynamic and functional adverse consequences, potentially leading to faster structural valve deterioration and a higher need of reoperation when compared with modifications of the David V-SARR operation. The cusps might touch the vascular graft in peak systole, although this has been shown not to be the case in many patients as reported by the Hannover group [10]. Opening and closing dynamics of the cusps might be faster than in the setting of preserved sinuses of Valsalva [6].…”

Section: Discussionmentioning

confidence: 88%

“…However, cusp degeneration because of touching of the cusps and prosthesis was not observed over a cumulative follow-up of 790 patient-years and there was no stroke or bleeding. The rate of survival was overall 93, 85 and 70% at 1, 5 and 10 years, and the rate of freedom from valve replacement 96, 91 and 87% [10], respectively.…”

Section: Results Of David I Type Of Valve-sparing Aortic Root Replacementioning

confidence: 99%

“…Shrestha et al, from Hannover [10], reported on the largest series of David I, with 450 patients, including 26 with confirmed MFS and a median age of 57 years. The hospital mortality rate was reported to be 4.8%, and 6 MFS patients required a reoperation during follow-up.…”

Section: Results Of David I Type Of Valve-sparing Aortic Root Replacementioning

confidence: 99%

“…All underwent the David I V-SARR procedure as described previously [4,5,8,9]. This procedure uses a single vascular graft to replace both the aortic root and ascending aorta without creating neo-sinuses or a neo-STJ [10]. Procedures were performed using standard aortic cannulation in n = 43 patients (90%) and cannulation of the axillary or femoral artery in five patients (10%).…”

Section: Introductionmentioning

confidence: 99%

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David I reimplantation procedure for aortic root replacement in Marfan patients: medium-term outcome

Kari

Beyersdorf

Rylski

et al. 2014

Interact CardioVasc Thorac Surg

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OBJECTIVES: Technical variations of the David reimplantation valve-sparing aortic root replacement (V-SARR) procedure have been proposed to be advantageous in patients with connective tissue disease, such as the Marfan syndrome (MFS). We report results of a Marfan cohort treated exclusively with the non-modified David I procedure.METHODS: Forty-eight Marfan patients (25 males, mean age 33 ± 12 years, range 15-62 years) underwent the original variant of the David V-SARR (David I) between 1997 and 2013. Forty-two operations (88%) were performed as elective procedures for aortic root aneurysms and six for acute dissections (12%). Seventeen had aortic regurgitation (AR) grades ≥2+ preoperatively, and 3 had AR >2+. No patients with severe AR (4+) were selected for V-SARR. Three full or hemi-arch replacements were performed. Patients who were operated on using a variation of the David I or David II procedure were excluded. RESULTS:Mean prosthesis size was 28 ± 3 mm (18-30 mm). Mean clinical and echocardiographic follow-up (98% complete) was 3.8 ± 3.7 years with a cumulative follow-up of 178 patient-years. The early mortality rate was 2% (one hospital death). The survival rate was 98% (95% confidence 84-99%) at 4 years and 90% (57-98%) at 8 years with 5 patients at risk at 10 years. The rate of freedom from root or valve reoperation was 97% (79-99%) and 97% (79-99%) at 4 and 8 years, respectively. Only one patient required mechanical aortic valve replacement for progression of AR. CONCLUSIONS:Despite potential theoretical drawbacks of the David I V-SARR technique without neo-sinuses or a neo-sinotubular junction, it results in a favourable mid-term outcome in Marfan patients and compares well with reported results of different modifications of David V-SARR.

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Section: Discussionmentioning

confidence: 88%

Section: Results Of David I Type Of Valve-sparing Aortic Root Replacementioning

confidence: 99%

Section: Results Of David I Type Of Valve-sparing Aortic Root Replacementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

David I reimplantation procedure for aortic root replacement in Marfan patients: medium-term outcome

Kari

Beyersdorf

Rylski

et al. 2014

Interact CardioVasc Thorac Surg

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“…Установлено, что женщинам, не страдающим синд-ромом Марфана, чаще необходим протез диаметром 26 мм, в то время как мужчинам -28 мм. У пациентов, страдающих синдромом Марфана и имеющих рас-ширенное фиброзное кольцо аортального клапана, имплантируемый сосудистый протез обычно на 2 мм шире, чем у пациентов без синдрома Марфана [21].…”

Section: Discussionunclassified

Choosing aortic valve plasty for aortic root/ascending aorta repair

Чарчян¹,

Белов²,

Скворцов³

et al. 2016

Patol krovoobrashch kardiokhir

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Aim: The study was designed to evaluate the outcomes of aortic valve reimplantation (David procedure), as well as various techniques of aortic root reconstruction. Methods: The results of 84 valve-sparing operations for thoracic aortic aneurysms and dissections were analyzed at B. Petrovsky Russian Research Center of Surgery over a period from 2007 to 2016. The first group (n = 42) consisted of patients after David procedure, the second group (n = 38) included patients after different methods of aortic root repair (fixation of commissures, leaflets plication, sinotubular ridge repair). 5-year results of surgical treatment were assessed. Results: David procedure is characterized by good long-term results. There was no in-hospital and 5-year mortality in the first group, while 2 (5.3%) patients in the second group died in the early postoperative period. In both groups the reoperation rate was 2.4% and 8.3% respectively. Conclusion: Valve-sparing aortic root repair is characterized by good survival rate, high freedom from reoperation and low incidence of complications.

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