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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
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Valve-Sparing Aortic Root Replacement as First-Choice Strategy in Acute Type a Aortic Dissection.
Hug Aubin1, Payam Akhyari1, Philipp Rellecke1
1Department of Cardiovascular Surgery, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
Frontiers in Surgery
|August 27, 2019
Summary
The David procedure, a valve-sparing aortic root replacement, shows promise as a primary treatment for acute aortic dissection type A. This study found it safe and feasible, with comparable outcomes to other methods despite longer operation times.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Background:
- Valve-sparing aortic root replacement (David procedure) is theoretically ideal for acute aortic dissection type A (AADA).
- Its use in AADA is limited by emergency conditions and procedural complexity.
- This study evaluates the David procedure as a primary strategy in AADA.
Purpose of the Study:
- To assess the safety and feasibility of the David procedure as a first-choice treatment for AADA.
- To compare outcomes between AADA patients treated with the David procedure and those treated with alternative strategies.
Main Methods:
- A consecutive series of 45 AADA patients operated on by a single surgeon were analyzed.
- The David procedure was prioritized unless contraindicated by valve pathology or patient status.
- Patients were followed for a median of 5.0 years.
Main Results:
- The David procedure was performed in 62.2% of patients; 37.8% received alternative strategies.
- David procedure group had significantly longer X-clamping, cardiopulmonary bypass, and total operation times.
- No significant differences were observed in major complication rates or 30-day and 5-year mortality between groups.
Conclusions:
- The David procedure can be a safe and feasible primary surgical option for AADA.
- Outcomes are comparable to alternative strategies, suggesting its potential as a first-line treatment.
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