Valve-sparing aortic root replacement using the on-pump beating heart technique

Over time, new and improved surgical techniques have been developed to enhance both effectiveness and safety. The traditional David's operation involves prosthetic replacement of the aortic root and ascending aorta and reimplantation of the aortic valve and the coronary arteries into a vascular prosthesis, all performed with cardiopulmonary bypass and cardioplegic myocardial arrest. Even modern methods of cardioplegia do not offer 100% protection against ischaemia during prolonged cardiac arrest due to the absence of coronary perfusion. We present a successful case of David's operation performed on a beating heart with parallel cardiopulmonary bypass. By avoiding cardioplegic cardiac arrest, we achieved a less invasive procedure with reduced stress on the heart, thereby minimizing the risk of postoperative complications and mortality.