A modified David V: Technique and outcomes from a large single centre experience

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Composite valve-graft replacement is standard for aortic root replacement.
• Valve-sparing aortic root replacement (VSARR) preserves the native aortic valve.
• Refinements in VSARR techniques, including remodeling and reimplantation, have improved outcomes.

Purpose of the Study:

• To describe the technical steps and outcomes of a modified David V procedure for VSARR.
• To evaluate the early and midterm results of this adapted Stanford modification.

Main Methods:

• Retrospective review of 185 patients who underwent adapted Stanford modification VSARR between November 2007 and March 2025.
• Data collected from a prospectively maintained institutional database.
• Analysis of patient demographics, procedural details, and clinical outcomes.

Main Results:

• Mean patient age was 47.6 years, with 81% males.
• Low mortality (0.5%) and no 30-day reinterventions.
• Excellent midterm results with 1, 5, and 10-year survival rates of 99%, 98%, and 92%, respectively.
• High freedom from aortic valve or re-operation rates: 99% (1 year), 97% (5 years), and 94% (10 years).
• No cases of greater than moderate aortic insufficiency on early echocardiographic follow-up.

Conclusions:

• Meticulous surgical technique and thorough valve assessment are crucial in VSARR.
• The modified David V procedure demonstrates favorable early and midterm outcomes.
• Graft type and size appear less critical than surgical precision in VSARR.