[Modified David's operation for aortic regurgitation associated with annulo-aortic ectasia]

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Composite graft replacement is indicated for aortic regurgitation (AR) with annuloaortic ectasia (AAE).
• Marfan syndrome frequently causes AAE and AR, necessitating complex surgical interventions.
• Traditional composite grafts replace both the ascending aorta and aortic valve, risking complications related to prosthetic valves.

Observation:

• A 29-year-old female with AR due to AAE and Marfan syndrome underwent a novel ascending aorta replacement.
• The procedure involved excising the aneurysmal aorta while meticulously preserving the native aortic valve and coronary artery origins.
• The aortic valve was reimplanted into a Dacron graft, and coronary arteries were reattached using a modified Piehler's procedure.

Findings:

• The surgery, termed "modified David's operation," was performed successfully under cardiopulmonary bypass.
• The patient experienced no operative complications and demonstrated a competent aortic valve postoperatively.
• A peak systolic pressure gradient of 20 mmHg across the aortic valve was observed, indicating good function.

Implications:

• This valve-sparing aortic graft replacement technique may reduce complications associated with prosthetic heart valves.
• The modified David's operation presents a viable alternative for managing aortic regurgitation in patients with annuloaortic ectasia and connective tissue disorders.
• Further research is warranted to evaluate the long-term efficacy and safety of this valve-preserving approach.