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David Procedure: A 21-year Experience With 300 Patients.
Sabrina Manganiello1, Jerome Soquet1, Agnes Mugnier1
1Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France.
The Annals of Thoracic Surgery
|June 1, 2022
Summary
The David procedure for aortic root aneurysm offers good long-term survival and low reintervention rates. Preoperative aortic insufficiency and ventriculoaortic junction size predict late valve issues.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Background:
- The David procedure is a valve-sparing alternative to the Bentall procedure for aortic root aneurysm.
- This study evaluates the long-term outcomes and failure predictors of the David procedure.
Purpose of the Study:
- To assess the long-term efficacy and safety of the David procedure.
- To identify factors predicting late failure after valve-sparing aortic root replacement.
Main Methods:
- A retrospective analysis of 300 patients undergoing the David procedure between 1998 and 2019.
- Long-term clinical and echocardiographic outcomes were analyzed with a median follow-up of 7.0 years.
Main Results:
- Early mortality was 1%, with no early valve-related reoperations.
- Overall survival rates at 5, 10, and 15 years were 95.3%, 91.1%, and 82.9%, respectively.
- Preoperative aortic insufficiency grade ≥ 2 and ventriculoaortic junction ≥ 29 mm predicted late postoperative aortic insufficiency.
Conclusions:
- The David procedure demonstrates favorable long-term survival and low reintervention rates.
- Preoperative aortic insufficiency and ventriculoaortic junction diameter are significant risk factors for late aortic insufficiency.
