Valve-sparing David procedure via minimally invasive access does not compromise outcome

Area of Science:

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

Background:

• The David procedure (aortic valve sparing-aortic root replacement) is complex and not routinely performed via minimally invasive approaches.
• Minimally invasive cardiac surgery offers potential benefits but requires specialized techniques for complex aortic procedures.

Purpose of the Study:

• To compare the outcomes of elective minimally invasive David procedures with those performed via conventional full sternotomy.
• To evaluate the safety and efficacy of minimally invasive access for aortic valve sparing-aortic root replacement.

Main Methods:

• A retrospective analysis of 220 patients undergoing elective isolated David-I procedures between 1993 and 2019.
• Patients were divided into two groups: mini-access (n=42) and full sternotomy (n=178).
• Outcomes including cardiopulmonary bypass time, aortic cross-clamp time, postoperative complications, survival rates, and freedom from re-operation were compared.

Main Results:

• Minimally invasive access had longer cardiopulmonary bypass (188.5 vs 149.0 min) and aortic cross-clamp times (126.2 vs 110.0 min) (p < 0.001).
• Postoperative aortic insufficiency was ≤ I° in 100% of the mini-access group versus 95% in the sternotomy group.
• In-hospital mortality, stroke rates, and reexploration for bleeding were comparable between groups. Long-term survival and freedom from re-operation rates were also similar.

Conclusions:

• Early postoperative results of the minimally invasive David procedure are comparable to conventional full sternotomy.
• Meticulous attention to hemostasis is critical for successful minimally invasive aortic valve sparing-aortic root replacement.
• Long-term outcomes, including aortic valve durability, appear comparable between the two approaches.