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Complex Cusp Repair in Patients Undergoing the David Procedure: Is It Worth It?
Hardy Baumbach1, Kristina Wachter1, Ragi Nagib1
1Department of Cardiovascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany.
The Annals of Thoracic Surgery
|April 27, 2016
Summary
Valve-sparing aortic root replacement with complex cusp repair shows excellent midterm results, offering comparable survival and low reoperation rates. This approach avoids anticoagulation, presenting a safe alternative for aortic repair.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Valve Disease
Background:
- Valve-sparing aortic root replacement (VSARR) demonstrates excellent long-term outcomes.
- VSARR offers low valve-related complications, comparable to conventional aortic valve replacement.
- The study investigates the efficacy of additional expanded cusp repair in VSARR.
Purpose of the Study:
- To evaluate the outcomes of VSARR with and without additional complex cusp repair.
- To compare cardiac death, aortic insufficiency, and reoperation rates between the two groups.
- To assess the midterm results of complex VSARR procedures.
Main Methods:
- Prospective data collection from 192 elective patients undergoing VSARR.
- Group I: Isolated David procedure (n=58).
- Group II: Complex David procedure with cusp repair (n=134), including plication, decalcification, or pericardial patch.
Main Results:
- In-hospital mortality was 3.4% (Group I) vs 0.0% (Group II).
- Five-year freedom from cardiac death was 83% (Group I) vs 98% (Group II).
- Five-year freedom from moderate/severe aortic insufficiency was 100% (Group I) vs 93% (Group II).
Conclusions:
- VSARR, even with complex cusp repair, yields excellent midterm survival and freedom from reoperation.
- This complex procedure offers a low risk of valve-related complications.
- Absence of anticoagulation therapy is a significant advantage of complex VSARR.
