[Early outcome of valve sparing aortic root replacement with partial upper sternotomy]

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Aortic root aneurysm and aortic regurgitation necessitate complex surgical repair.
• The David procedure offers valve sparing aortic root replacement, preserving native valve function.
• Minimally invasive techniques like partial upper sternotomy aim to reduce surgical trauma.

Purpose of the Study:

• To evaluate the early clinical outcomes of valve sparing aortic root replacement with the reimplantation technique (David procedure) performed via a partial upper sternotomy.
• To assess the safety and feasibility of this minimally invasive approach for aortic root surgery.

Main Methods:

• A prospective study of 31 patients undergoing David procedure with partial upper sternotomy between April 2016 and April 2020.
• Patients had varying degrees of preoperative aortic regurgitation and aortic dimensions.
• Surgical variations included concomitant procedures like ascending aorta replacement and thoracic endovascular aortic repair.

Main Results:

• No operative mortality or major complications (stroke, myocardial infarction, renal insufficiency) were observed.
• Significant improvement in aortic regurgitation postoperatively, with most patients experiencing no or only mild regurgitation.
• Short intubation times (14±3 hours) and ICU stay (2.1±1.5 days) indicate favorable early recovery.

Conclusions:

• Valve sparing aortic root replacement using the David procedure via partial upper sternotomy is a safe and feasible surgical option.
• The early results demonstrate satisfactory functional outcomes and significant reduction in aortic regurgitation.
• This minimally invasive approach offers a promising alternative for patients requiring aortic root repair.