David Operation in the Bicuspid Aortic Valve Population

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Defects
• Aortic Valve Disease

Background:

• Bicuspid aortic valve (BAV) is the most common congenital heart defect, affecting 1-2% of the population.
• BAV is often associated with aortic disease, such as annular ectasia.
• Valve-sparing root re-implantation surgery is an emerging option for BAV patients with aortic disease.

Purpose of the Study:

• To compare the short- and long-term outcomes of the David procedure in patients with BAV and aortic root ectasia.
• To evaluate the efficacy and safety of valve-sparing surgery in this specific patient group.

Main Methods:

• Retrospective analysis of 42 patients with aortic annular ectasia undergoing valve-sparing root re-implantation (David procedure) between 2007-2015.
• Comparison of 11 BAV patients with 31 tricuspid aortic valve (TAV) patients.
• Statistical analysis using univariate methods (t-test, chi-squared) and Kaplan-Meier curves for survival and re-intervention rates.

Main Results:

• 100% follow-up achieved (mean 60 months); BAV patients were younger at operation.
• BAV group had longer cardiopulmonary bypass and cross-clamp times, and required universal aortic plasty.
• Short-term complications were similar, except for a higher need for pacemakers in the BAV group. Long-term survival and freedom from re-intervention were comparable.

Conclusions:

• Valve-sparing root re-implantation is a viable option for BAV patients with aortic root ectasia, offering acceptable short- and long-term results comparable to TAV patients.
• Key challenges include the need for aortic valve plasty and an increased risk of atrioventricular block in BAV patients.
• Further research with larger cohorts and comparison to the Bentall procedure is warranted.