Valve-sparing aortic root replacement using the reimplantation (David) technique: a systematic review and meta-analysis on survival and clinical outcome

Mastrobuoni, Stefano; Govers, Pascal J.; Veen, Kevin M.; Jahanyar, Jama; Saane, Silke van; Segreto, Antonio; Zanella, Luca; Kerchove, Laurent de; Takkenberg, Johanna J. M.; Arabkhani, Bardia

doi:10.21037/acs-2023-avs1-0038

Cited by 2 publications

(1 citation statement)

References 47 publications

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“…The findings of the present systematic review and meta-analysis are notably in-keeping with other contemporary reviews, though the focus of these studies tends to be on patients with connective tissue disorders (e.g., Marfans, Loeys-Dietz) or acute aortic catastrophes ( 40 - 42 ). Another systematic review and meta-analysis published recently by our fellow colleagues, with a sole focus on the David procedure utilized in cohorts after 2010, is the most supportive of the presented results, with freedom from mortality and secondary reoperation almost directly comparable to our cohort ( 43 ). The combined, independently derived results, highlight the significant freedom from secondary operation through to long-term follow-up.…”

Section: Discussionsupporting

confidence: 83%

The outcomes of three decades of the David and Yacoub procedures in bicuspid aortic valve patients—a systematic review and meta-analysis

Wilson-Smith¹,

Wilson-Smith²,

Smith³

et al. 2023

Ann Cardiothorac Surg

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Background Valve-sparing aortic procedures, including the David and Yacoub procedures, have emerged as the dominant approaches in aortic aneurysm surgery, preserving the native aortic valve and thereby conferring significant prognostic benefits to the patient. Over the years, these procedures have also shown promise in patients with bicuspid valve-related aortopathy. This systematic review and meta-analysis presents the most up-to-date data on perioperative outcomes, freedom from secondary reoperation, and freedom from mortality for bicuspid valve patients undergoing valve-sparing aortic operations. Methods The methods for this systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Four databases were searched, ultimately yielding 19 papers for inclusion, using appropriate search terminology. Meta-analysis using proportions or means, as appropriate, were applied. Kaplan-Meier curves were digitized and aggregated using previously validated techniques. Results A total of 1,159 patients were included. Males accounted for 87.4% of the cohort. The mean age of the cohort was 44.9 years. The mean aortic root diameter was estimated to be 46.3 mm, with an estimated range from 38 to 54 mm. Thirty-day mortality rate was estimated to be 1.7%. Eighty-five percent of patients in this series received the David approach, with the remainder receiving the Yacoub approach. Overall, there was low heterogeneity observed for the mean length of intensive care stay, while high heterogeneity was observed for the other remaining variables of interest. Kaplan-Meier survival estimation at 5, 10, and 15 years was 96%, 90%, and 87%, respectively. Kaplan-Meier freedom from secondary reoperation at 5, 10, and 15 years was 96%, 91%, and 88%, respectively. Conclusions This review demonstrates the durability and safety of the David and Yacoub valve-sparing procedures across long-term follow-up in bicuspid aortic valve patients. These procedures offer significant freedom from mortality and secondary reoperations on the aorta and valve and will likely continue to demonstrate excellent results into the future. There is a clear transition towards the David procedure, with the bulk of contemporary literature publishing on this technique.

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Section: Discussionsupporting

confidence: 83%