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Implementing David Procedure in Latin America: Closing the Gap with High-Income Countries.

Gustavo Prieto¹, Johiner Vanegas¹, Jesús Guerrero¹

¹Fundación Cardiovascular de Colombia Department of Cardiovascular Surgery Floridablanca Colombia Department of Cardiovascular Surgery, Fundación Cardiovascular de Colombia, Floridablanca, Colombia.

Brazilian Journal of Cardiovascular Surgery

|June 23, 2026

Summary

The David procedure for aortic root repair is a low-risk option with excellent outcomes, even in complex cases. This aortic valve sparing surgery offers significant benefits, especially for patients in middle-income countries.

Keywords:

Aortic Valve-Sparing Operations David Procedure Reimplantation Technique.

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Area of Science:

Cardiovascular Surgery
Thoracic Surgery
Aortic Valve Surgery

Background:

The David procedure, an aortic valve sparing surgery, offers advantages over prosthetic valves, including freedom from anticoagulation and reintervention.
Specific benefits may be relevant for populations in middle-income countries due to sociodemographic factors.

Purpose of the Study:

To evaluate the clinical and perioperative outcomes of the David procedure in a Colombian cohort.
To assess the short-term follow-up results of aortic valve sparing surgery in a middle-income country setting.

Main Methods:

Retrospective analysis of 103 patients undergoing the David procedure between November 2021 and June 2024.
Inclusion of perioperative results and short-term follow-up data.

Main Results:

30-day mortality was 0.9%, with no perioperative myocardial infarction or dialysis requirement.
One-year survival rate was 99%, with 100% freedom from reintervention and endocarditis.
67% freedom from anticoagulation at one year; atrial fibrillation occurred in 29.13%.

Conclusions:

The David procedure is an effective aortic valve sparing surgery with favorable outcomes in this Colombian cohort.
Results are comparable to those reported in high-income countries, highlighting its potential in middle-income settings.