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Updated: Jun 27, 2026

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots

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Published on: May 21, 2017

Bentall Versus David Procedure for Aortic Root Replacement in Patients With Bicuspid Aortic Valve: Systematic Review

Ioannis Zoupas¹, Andreas Sarantopoulos², Nikolaos Schizas¹

¹4(th) Department of Cardiac Surgery, Hygeia Hospital, Athens, Greece.

Heart, Lung & Circulation

|September 17, 2025

Summary

For bicuspid aortic valve (BAV) patients, the David operation offers improved survival and fewer complications compared to the Bentall procedure. Freedom from re-operation rates were similar between the two surgical approaches.

Keywords:

BAV Bentall Bicuspid Composite David Re-implantation

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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

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Published on: March 26, 2018

Area of Science:

Cardiovascular Surgery
Aortic Root Replacement
Bicuspid Aortic Valve Disease

Background:

Limited evidence compares valve-sparing aortic root replacement (David procedure) with composite graft replacement (Bentall procedure) in bicuspid aortic valve (BAV) patients.
This study addresses the comparative effectiveness of these two aortic root replacement techniques in BAV patients.

Purpose of the Study:

To compare overall survival and freedom from re-intervention between the David procedure and the Bentall procedure in patients with BAV.
To evaluate postoperative complication rates associated with each surgical approach in BAV patients.

Main Methods:

Systematic review and meta-analysis of thirteen studies including 1,264 BAV patients (Bentall) and 602 BAV patients (David).
Follow-up period of 8 years.
One-stage and two-stage meta-analyses utilized Kaplan-Meier data and a random-effects model, adhering to PRISMA guidelines.

Main Results:

The David procedure demonstrated significantly improved overall survival rates compared to the Bentall procedure (HR 0.19, p<0.001).
Freedom from re-intervention rates were comparable between the David and Bentall procedures (HR 1.24, p=0.575).
Fewer postoperative complications were observed following the David operation.

Conclusions:

The David operation is associated with superior survival and reduced complication rates compared to the Bentall procedure in BAV patients.
Both procedures showed similar rates of freedom from re-operation.