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Updated: May 15, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Midterm results of David reimplantation in patients with connective tissue disorder
Lars G Svensson1, Eugene H Blackstone, Mazin Alsalihi
1Marfan Syndrome and Connective Tissue Disorder Clinic, Cleveland, Ohio 44195, USA. svenssl@ccf.org
Background:
Few series have examined follow-up risks of the David reimplantation operation in patients with connective tissue disorder. Hence, we assessed its midterm safety and effectiveness for Marfan syndrome and other connective tissue disorders, such as Ehlers-Danlos, Loeys-Dietz, and marfanoid syndromes.
Methods:
Of 313 patients who underwent modified David reimplantation, 178 identified as having connective tissue disorders underwent operation from January 1, 1991, to December 31, 2010. These disorders included Marfan (84%), marfanoid (8.4%), Loeys-Dietz (5.6%), Ehlers-Danlos (1.1%), and other syndromes (1.1%). Concomitant procedures included mitral valve repair in 7.3% and an atrial fibrillation procedure in 3.4%.
Results:
There were no operative or 30-day deaths. Complications included prolonged ventilation (3%), renal failure (3%), reoperation for bleeding (2.2%), and permanent stroke (0.56%). Eight-year survival was 94% and freedom from aortic valve reoperation at 6 years was 92%. Of the 7 aortic valve reoperations, 3 were attributable to endocarditis and 3 to technical failure. One reoperation was performed at another hospital, and the reason could not be determined. There were no late strokes or hemorrhagic events. At 4 years, approximately 70% of patients had no aortic valve regurgitation, and 18% were in grade 1+.
Conclusions:
Prophylactic root and valve preservation using David reimplantation is safe and provides excellent midterm effectiveness and low risk of late events except for endocarditis.
Insights
The David reimplantation operation is safe for patients with connective tissue disorders, offering excellent midterm effectiveness and low risk of late aortic valve issues, except for endocarditis.
Area of Science:
- Cardiovascular Surgery
- Aortic Valve Surgery
- Connective Tissue Disorders
Background:
- Limited data exists on the long-term risks of the David reimplantation operation in patients with connective tissue disorders.
- This study addresses the midterm safety and effectiveness of this procedure in Marfan syndrome and related conditions.
Purpose of the Study:
- To evaluate the midterm safety and effectiveness of the modified David reimplantation operation.
- To assess the follow-up risks associated with this procedure in patients with connective tissue disorders.
Main Methods:
- A retrospective review of 178 patients with connective tissue disorders who underwent modified David reimplantation between 1991 and 2010.
- Analysis of patient demographics, concomitant procedures, and post-operative outcomes.
Main Results:
- No operative or 30-day mortality was observed.
- Midterm survival was 94% at 8 years, with 92% freedom from aortic valve reoperation at 6 years.
- Complications included prolonged ventilation, renal failure, reoperation for bleeding, and stroke; aortic valve regurgitation was minimal at 4 years.
Conclusions:
- Prophylactic aortic root and valve preservation using the David reimplantation technique is safe.
- The procedure demonstrates excellent midterm effectiveness with a low risk of late aortic valve events, excluding endocarditis.
