Key result
David procedure linked to ~47% lower mortality versus Bentall in Marfan syndrome.
Why the study?
The valve-sparing David procedure is increasingly favored over the composite valve-graft Bentall procedure for patients with Marfan syndrome requiring aortic root surgery, but real-world comparative long-term outcomes data remain limited.
Does the valve-sparing David procedure reduce all-cause mortality and prosthetic device complications compared to the composite valve-graft Bentall procedure in patients with Marfan syndrome requiring aortic root surgery?
Cohort (n=711)
Yes
Does the valve-sparing David procedure reduce all-cause mortality and prosthetic device complications compared to the composite valve-graft Bentall procedure in patients with Marfan syndrome requiring aortic root surgery?
In patients with Marfan syndrome undergoing aortic root replacement, the valve-sparing David procedure is associated with significantly lower long-term all-cause mortality and fewer prosthetic device complications compared to the Bentall procedure.
May support David preference in Marfan aortic surgery; leaves open randomized confirmation of survival benefit.
Background For patients with Marfan syndrome requiring aortic root surgery, the valve-sparing David procedure aims to avoid the prosthetic valve complications associated with the composite valve-graft Bentall procedure. Although increasingly favored, real-world comparative long-term outcomes data remain limited. Purpose This study aims to compare real-world long-term outcomes, including mortality, prosthetic device complications, and healthcare utilization, between the David and Bentall procedures in patients with Marfan syndrome. Methods A retrospective cohort study was performed using the TriNetX US Collaborator Network, identifying 711 patients with Marfan syndrome (David, n=322; Bentall, n=389). The primary outcomes were all-cause mortality and complications of cardiac or vascular prosthetic devices. Comparative analyses utilized Kaplan-Meier survival, Cox proportional hazards models (HR), and risk ratios (RR). Absolute risk differences (ARD) and numbers needed to harm (NNH) were calculated to quantify clinical impact. Results The David cohort was significantly younger (38±14 vs 50±17 years, p<0.001). The David procedure was associated with a 46.6% lower risk of all-cause mortality (HR 0.534, 95% CI: 0.308–0.925) and a 45.2% lower risk of prosthetic device complications at five years (HR 0.538, 95% CI: 0.292–0.99). The absolute risk reduction for mortality was 7.7% (NNH=13) and for five-year device complications was 4.3% (NNH=23). There were no significant differences in intensive care unit (ICU) utilization at any time point (30 days to five years) between the two groups. Conclusion In this real-world analysis, the valve-sparing David procedure was associated with significantly superior long-term survival and reduced prosthetic device complications compared to the Bentall procedure in patients with Marfan syndrome, supporting its preferential use when anatomically feasible.
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Hammadeh et al. (2026) conducted a cohort in Marfan syndrome requiring aortic root surgery (n=711). Valve-sparing David procedure vs. Composite valve-graft Bentall procedure was evaluated on All-cause mortality and complications of cardiac or vascular prosthetic devices (HR 0.534, 95% CI 0.308-0.925). The valve-sparing David procedure was associated with lower all-cause mortality (HR 0.534; 95% CI 0.308-0.925) and 5-year prosthetic complications (HR 0.538) vs Bentall in Marfan syndrome.
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