Aortic valve-sparing reimplantation technique (David-procedure) in different pathologies: Long-term clinical and echocardiographic follow-up in 170 patients. A single-center experience

Objective: The David-procedure, introduced almost 20 years ago, has evolved into reasonable and useful surgical measure, but its long-term results still need to be defined. Methods: Between 08/1998–03/2009, a cohort of 170 patients (45 females, 125 males; mean age 56±15yrs; range 12 to 79yrs) underwent the David-procedure for regurgitation (ascending aneurysm n=145 and AADA n=15) or without regurgitation (ascending aneurysm n=10) of a tricuspid (n=153) or a bicuspid (n=17) aortic valve (AV). Additionally cusp repair was carried out in 39 patients (tricuspid AV n=28, bicuspid AV n=11). Combined procedures were performed in 83 patients (hemi/full-arch replacement n=26/21, CABG n=34, mitral/tricuspid valve reconstruction n=9/1, ASD/VSD-repair n=6/1). Patients were followed clinically and echocardiographically; follow-up was complete in 90% (mean: 4.6±2.7, range 0.01–11.3yrs) and a totalled 685.5 patient-years. Results: Complications included hospital mortality in 2 patients, endocarditis in 1, perioperative myocardial infarction in 2, perioperative bleeding in 6, thrombo-embolism in 1 and pacemaker implants in 5. Freedom from valve-related complications (aortic insufficiency grade >2) at 5 and 10yrs were 93.7% and 90.4% in tricuspid AV, at 5yrs was 93.5% in bicuspid. Freedom from valve replacement at 5 and 10yrs were 93.7% and 88.7% in tricuspid AV, at 5yrs was 93.8% in bicuspid. Echocardiography revealed AV median peak gradients of 8.4±8.0 in tricuspid, 9.6±4.6 in bicuspid AV. Conclusion: Long-term excellent hemodynamic results, low morbidity, mortality and reoperation requirement support the reconstructive surgery of the AV and justify its further utilization.