David procedure in patients with aortic dissection

OBJECTIVE To analyze the results of David procedure in patients with aortic dissection. MATERIAL AND METHODS There were 149 patients who underwent David procedure between July 2013 and May 2022. Of these, 30 (20.1%) ones had aortic dissection. The mean follow-up period was 3.4±2.3 years, mean age of patients — 42±12 years. There were 8 (26.7%) females and 22 (73.3%) males. Eight (26.7%) patients had Marfan syndrome, 2 (6.7%) — undifferentiated form of connective tissue disorders, 20 (66.7%) patients — DeBakey type 1 aortic dissection, 6 (20.0%) patients — type 2, 4 (13.3%) patients — type 3. Acute dissection was observed in 10 (33.3%) causes, subacute — in 9 (30%) causes, chronic — in 11 (36.7%) cases. We analyzed early and mid-term postoperative results: survival, mortality, recurrent aortic insufficiency, freedom from redo surgeries, aortic insufficiency ≥2, diameter of aortic annulus, coaptation depth and length. RESULTS Mean diameter of aortic annulus before, after surgery and in long-term postoperative period was 26.5±2.4, 22.6±1.3 mm and 24±2.2 mm, respectively (p=0.007). Mean coaptation depth before surgery and in long-term postoperative period was 7.0±1.2 and 4.7±2.3 mm (p=0.048), coaptation length — 7.1±1.2 and 7.1±1.7 mm, respectively (p=0.629). Eleven (36%) patients had mild aortic insufficiency intraoperatively and at discharge. Other ones had no aortic insufficiency. In-hospital mortality was 3.3% (n=1), mid-term mortality — 3.3% (n=1), freedom from valve-related redo surgery — 100%, freedom from aortic insufficiency ³2 — 100%. Annual, 5- and 9-year survival was 96.7, 96.7 and 92.5%, respectively. CONCLUSION David procedure results excellent postoperative outcomes in patients with aortic dissection. This surgical technique has significant advantages over valve replacement and may be beneficial for patients with aortic dissection despite technical complexity and duration.