Key result
Larger aortic annulus linked to ~8-fold higher odds of major postoperative complications after David procedure.
Why the study?
Associations between preoperative aortic geometry, intraoperative technical challenges, and early major postoperative complications after David reimplantation were not well characterized.
Does preoperative aortic geometry predict early major postoperative complications in adults undergoing a reimplantation-based David procedure?
Cohort (n=111)
No
Does preoperative aortic geometry predict early major postoperative complications in adults undergoing a reimplantation-based David procedure?
Odds Ratio: 8.07 (95% CI 3.18–25.01)
Larger annular and ascending aortic diameters are significantly associated with an increased risk of early major postoperative complications after David reimplantation procedures.
Larger aortic diameters were associated with higher complication odds after David reimplantation; hypothesis-generating and should not yet change practice.
Objective To assess associations between preoperative aortic geometry, intraoperative technical challenges, and early major postoperative complications after David reimplantation and to describe corrective strategies. Methods We retrospectively studied 111 consecutive adults undergoing a reimplantation-based David procedure performed by one senior surgeon from September 2019 to April 2026. The primary endpoint comprised reoperation for bleeding, unplanned nonbleeding reoperation, death, or stroke/transient ischemic attack after operating room departure during the index hospitalization or within 30 days. Firth logistic regression addressed limited events and sparse cells; threshold stability was assessed with 5,000 bootstrap resamples. Results Major postoperative complications and 5-component technical challenges occurred in 24 (21.6%) and 22 (19.8%) patients, respectively. Per 5-mm increase in annular and ascending aortic diameter, adjusted odds ratios were 8.07 (95% confidence interval, 3.18-25.01) and 4.66 (95% confidence interval, 2.31-12.06), respectively. The technical-challenge composite was not associated after adjustment for the European System for Cardiac Operative Risk Evaluation II and annular diameter. Among 17 patients with residual aortic regurgitation (AR) on initial transesophageal echocardiography (TEE), 6 underwent repeat cross-clamping and 3 underwent same-operation Bentall rescue; 104 of 106 patients had less than moderate AR on final TEE. Fourteen of 19 patients with hemostatic difficulty underwent reoperation for bleeding. Conclusions Larger annular and ascending aortic diameters were associated with major postoperative complications, whereas the technical-challenge composite was not independently associated after adjustment. A large annulus signals greater reconstructive burden but is not an exclusion criterion and warrants preparation, TEE-guided quality control, and correction or definitive intraoperative rescue.
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Vural et al. (2026) conducted a cohort in Aortic root disease requiring David procedure (n=111). Larger annular and ascending aortic diameter vs. Smaller annular and ascending aortic diameter was evaluated on reoperation for bleeding, unplanned nonbleeding reoperation, death, or stroke/transient ischemic attack after operating room departure during the index hospitalization or within 30 days (OR 8.07, 95% CI 3.18-25.01). Larger annular and ascending aortic diameters were associated with increased odds of major postoperative complications (OR 8.07, 95% CI 3.18-25.01 and OR 4.66, 95% CI 2.31-12.06 per 5-mm increase).
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