Expanding the indications for the David V aortic root replacement: early results

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• The David V procedure is a type of valve-sparing aortic root replacement.
• Expanded use of the David V procedure in higher-risk patients requires evaluation.

Purpose of the Study:

• To assess the early outcomes of the David V valve-sparing aortic root replacement in patients with aortic dissection, severe aortic insufficiency (AI), or those undergoing reoperative cardiac surgery.

Main Methods:

• A retrospective review of 150 David V procedures from 2005-2011.
• Comparison of 78 patients in an expanded, higher-risk group with 72 patients in a traditional, elective group.
• Follow-up data were 88% complete with a mean follow-up of 19 months.

Main Results:

• Overall 6-year survival was 95%, with 3 operative deaths (2.2%) in the expanded group.
• Freedom from moderate AI was 93%, and freedom from aortic valve replacement was 98% at follow-up.
• No significant difference in freedom from moderate AI between expanded (91%) and traditional (95%) groups.

Conclusions:

• The David V procedure is safe and effective for selected patients with expanded indications, including aortic dissection, severe AI, and reoperative surgery.
• Excellent short-term valve function and durability were observed.
• The procedure demonstrated a low rate of valve-related complications in this cohort.