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How We Perform a David Procedure With an Upper Hemisternotomy Approach.

Vishal N Shah1, Maxwell F Kilcoyne2, Meghan Buckley2

  • 1Department of Cardiothoracic Surgery, 12284University of Nebraska Medical Center, Omaha, NE, USA.

Innovations (Philadelphia, Pa.)
|December 9, 2021
PubMed
Summary

Minimally invasive valve-sparing aortic root replacement (David procedure) using an upper hemisternotomy (UHS) is safe and effective. This technique offers comparable outcomes to traditional full sternotomy, with no increase in mortality or complications.

Keywords:
David procedureaneurysmbicuspidupper hemisternotomyvalve-sparing aortic root replacement

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Area of Science:

  • Cardiovascular Surgery
  • Minimally Invasive Cardiac Surgery
  • Aortic Root Aneurysm Repair

Background:

  • Valve-sparing aortic root replacement (David procedure) is the gold standard for aortic root aneurysms in select patients.
  • Traditional David procedures utilize full sternotomy, limiting minimally invasive options.
  • Upper hemisternotomy (UHS) presents a potential minimally invasive alternative.

Purpose of the Study:

  • To describe a systematic approach to the David procedure using an upper hemisternotomy (UHS).
  • To compare perioperative safety outcomes of UHS David procedure versus traditional full sternotomy (FS) David procedure.

Main Methods:

  • A J-type upper hemisternotomy (UHS) approach was utilized.
  • Ascending aorta and femoral vein cannulation were performed using Seldinger technique under transesophageal echocardiographic guidance.
  • Perioperative safety outcomes were compared between 16 patients undergoing elective UHS David procedure and 27 patients undergoing elective FS David procedure.

Main Results:

  • No significant differences in cardiopulmonary bypass or aortic cross-clamp times were observed between UHS and FS cohorts.
  • Custodiol-HTK cardioplegia and Cor-Knot devices were used more frequently in the UHS cohort.
  • No in-hospital or 30-day mortality occurred in either cohort; ICU and hospital stays were comparable.

Conclusions:

  • The David procedure performed via upper hemisternotomy (UHS) is a safe and reproducible technique.
  • UHS offers a viable minimally invasive alternative for aortic root replacement.
  • This approach demonstrates comparable safety and efficacy to the traditional full sternotomy method.