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Updated: Jul 2, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Isolated aortic valve-sparing aortic root replacement in elective patients with bicuspid aortic valve: A
Karl Christian König1, Nina Feirer1, Miriam Lang1
1Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany.
Objective:
The David-I procedure is the standard surgical treatment for patients with aortic root aneurysms and preserved aortic valve morphology. Its application in patients with bicuspid aortic valves presents additional challenges. This study compares long-term outcomes of the elective, isolated David-I procedure in patients with bicuspid aortic valves and tricuspid aortic valves.
Methods:
We retrospectively reviewed all elective patients undergoing an isolated David-I procedure between 2004 and 2019. Patients with bicuspid aortic valves or tricuspid aortic valves and isolated aortic root aneurysms with or without aortic regurgitation due to annular dilatation were included, independent of severity. Patients with structural aortic valve disease were scheduled for a Bentall procedure. Surgical indications followed European Society of Cardiology and American College of Cardiology/American Heart Association guidelines. Emergency and concomitant procedures were excluded. Follow-up data were obtained from patient questionnaires and echocardiographic reports from referring cardiologists.
Results:
Thirty-five patients with bicuspid aortic valves and 134 patients with tricuspid aortic valves were included. Patients with bicuspid aortic valves were significantly younger (45.3 ± 11 vs 51.8 ± 12 years, P = .002). Median follow-up was 10 years (interquartile range, 4-12). Mortality was 0% in the bicuspid aortic valve group and 6.7% in the tricuspid aortic valve group (P = .002). Redo procedures were required more frequently in the bicuspid aortic valve group (22.9% vs 7.5%, P = .014). Moderate to severe aortic regurgitation occurred in 25.7% of the bicuspid aortic valve group and 18.7% of the tricuspid aortic valve group, without significant difference.
Conclusions:
The elective, isolated David-I procedure can be performed with excellent long-term survival in patients with bicuspid aortic valves. However, compared with tricuspid valves, patients with bicuspid aortic valves show a higher rate of redo procedures, indicating the need for careful patient selection and long-term follow-up.
