Twenty-five year experience with aortic valve-sparing root replacement in a single teaching center

Area of Science:

• Cardiovascular Surgery
• Aortic Valve Disease
• Surgical Outcomes

Background:

• Aortic valve-sparing root replacement (AVSRR) is a complex surgical technique.
• It is an attractive option for aortic root replacement, especially in younger individuals.
• The David operation is a specific AVSRR procedure.

Purpose of the Study:

• To evaluate the long-term results of the David operation for AVSRR.
• To analyze outcomes in a teaching institution that does not specialize in AVSRR.
• To assess the procedure's efficacy over a 25-year period.

Main Methods:

• A retrospective analysis of 131 patients undergoing the David operation between 1996 and 2019.
• Data collected from electronic medical records and direct patient/physician follow-up.
• Analysis included perioperative outcomes and long-term reoperation rates.

Main Results:

• 30-day mortality was 2%; 97% had good aortic regurgitation post-surgery.
• At 10-year follow-up, 12% required reoperation for root-related complications.
• Reoperation-free survival was 87.0% at 10 years; bicuspid valves or severe regurgitation did not impact survival, but larger LV end-diastolic diameter did.

Conclusions:

• The David operation can achieve excellent perioperative and 10-year outcomes.
• These results are achievable in centers that are not high-volume AVSRR programs.
• The procedure is a viable option for aortic root repair with good long-term results.