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February 26, 2020European Journal of Cardio-Thoracic SurgeryOpen Access

Aortic valve-sparing root replacement in patients with bicuspid aortic valve: long-term outcome with the David I procedure over 20 years

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Why the study?

While aortic valve-sparing root replacement is an established option for tricuspid aortic valves, its durability in patients with bicuspid aortic valves remains debated.

Does the David I procedure provide durable long-term outcomes in patients with bicuspid aortic valves compared to those with tricuspid aortic valves?

Population

50 patients with bicuspid aortic valve undergoing the David I procedure

Comparison

David I procedure in bicuspid vs tricuspid aortic valve patients

Design

Observational cohort study

Follow-up

Mean 11 ± 5.2 years

Authors

EBErik BeckmannVascular / Pulmonary VascularAMAndreas MartensCarl von Ossietzky Universität OldenburgHKHeike KrügerMedizinische Hochschule Hannover

Discussion

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Member takes

Implication

Supports David I in selected BAV patients; extends durability data to 20 years but leaves open randomized confirmation.

Structured PICO

Does the David I procedure provide durable long-term outcomes in patients with bicuspid aortic valves compared to those with tricuspid aortic valves?

P
Population
582 patients who underwent the David I procedure, including a cohort of 50 patients with a bicuspid aortic valve (mean age 46 ± 13 years, 80% men).
I
Intervention
David I procedure (aortic valve-sparing root replacement), with cusp plication performed in 34% and commissure repair in 8% of the bicuspid cohort.
C
Comparator
Patients with intact tricuspid aortic valves undergoing the David I procedure.
O
Outcome
Survival rates and freedom from valve-related reoperation at 1, 5, 10, and 20 years.hard clinical

The David I procedure offers excellent long-term survival and freedom from reoperation in carefully selected patients with bicuspid aortic valves, with durability comparable to that seen in tricuspid aortic valves.

Limitations

  • Careful patient selection might have contributed to the favorable outcomes

Cite This Study

Beckmann et al. (2020) studied this question.

synapsesocial.com/papers/6a70aab484cc45bb7bdfce50https://doi.org/10.1093/ejcts/ezaa083
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Reoperation of Left Heart Valve Bioprostheses According to Age at Implantation2011 · 119 citations
  2. 2Guidelines for reporting mortality and morbidity after cardiac valve interventions2008 · 291 citations
  3. 3Valve-sparing aortic root replacement (David I procedure) in Marfan disease: single-centre 20-year experience in more than 100 patients†2018 · 47 citations
  4. 4Early and long-term results of aortic valve sparing aortic root reimplantation surgery for bicuspid and tricuspid aortic valves2019 · 17 citations
  5. 5Long-term results after aortic valve-sparing operation (David I)2011 · 109 citations