The outcome after aortic valve-sparing (David) operation in 179 patients: a single-centre experience

OBJECTIVES: The David aortic valve-sparing reimplantation (AVr-D) operation is increasingly being used in patients with aortic root an-eurysmal disease and pliable aortic cusps. The objective of this study was to assess our early and medium-term outcomes with the AVr-D operation. METHODS: Between 2003 and 2011, a total of 179 patients underwent AVr-D procedures. The mean patient age was 49.7 ± 15.1 years, and 23.5 % (n = 42) were females. Marfan syndrome was present in 17.3 % of patients (n = 31), and acute Type A aortic dissection in 15.6 % (n = 28). Clinical follow-up was 100 % complete and was 1.8 ± 1.6 years (0 days to 7.5 years) long. Echocardiographic follow-up was performed 2.2 ± 1.5 years (0 days to 7.5 years) postoperatively and was 77 % complete. RESULTS: Early mortality was 1.1 % (n = 2), with both deaths occurring in patients with Type A dissection. Pre-discharge echocardiog-raphy revealed no patients with2+ aortic insufficiency (AI), 19.6 % of patients (n = 34) with 1+ or 2+ AI and 80.4 % of patients (n = 145) with trace or no AI. Left ventricular end-diastolic diameters decreased significantly from 5.6 ± 0.9 to 5.1 ± 0.8 cm early postoperatively (P 0.01). Transvalvular maximum gradients were similar before discharge and at last follow-up (10.6 ± 5.4 vs. 10.0 ± 8.2 mmHg, P = 0.4). AI grade increased significantly over time (0.3 ± 0.4 before discharge vs. 0.5 ± 0.6 at follow-up, P = 0.01), but remained less than moder-ate in 93.6 % of patients. Four patients required aortic valve re-replacement during follow-up, two due to early endocarditis and two due to non-coronary leaflet prolapse in Marfan patients. Five-year freedom from aortic valve reoperation was 95.9 ± 2.0%.