Aortic valve sparing aortic root replacement (David procedure) via an upper hemisternotomy: Hannover experience

Background: Due to its complexity, the David procedure is not routinely performed via an upper mini hemisternotomy. We present our results with David procedure performed via an upper hemi-sternotomy. Methods: Between Apr 2011 and Dec 2018, 62 patients (55 males, age 48.5±12.1 years) underwent elective aortic valve sparing root replacement (David procedure) via an upper hemisternotomy. Thirty patients (48.4%) underwent additional leaflet repair. Concomitant procedures were: five (8.1%) proximal aortic arch replacements and two (3%) coronary artery bypass grafting (CABG) to the proximal right coronary artery (RCA). Results: There were no intra-operative conversions to full sternotomy. The aortic cross-clamp and cardiopulmonary bypass (CPB) times were 126.4±28.8 and 191.4±39 min, respectively. Five patients (8.1%) were re-opened (via same access) due to post-operative bleeding. The post-operative ventilation time was 0.6±1.0 days. There was one 30-day mortality (1.6%). Conclusions: In carefully selected patients, the David procedure can be performed safely via an upper hemi-sternotomy. Attention to surgical details, especially hemostasis is even more important when choosing this access to prevent perioperative complications.