Additional cusp reconstruction does not compromise valve durability and mid-term survival after the David procedure: results from 449 patients. (14th May 2020)

• Record Type: Journal Article
• Authors: Liebrich, Markus; Charitos, Efstratios; Stadler, Charlotte; Roser, Detlef; Merk, Denis R; Doll, Nicolas; Hemmer, Wolfgang; Voth, Vladimir
• Is Part Of: European journal of cardio-thoracic surgery. Volume 58:Number 5(2020)
• Page Start: 1072
• Page End: 1079
• Publication Date: 2020-05-14
• Subjects: David procedure -- Cusp reconstruction -- Bicuspid and tricuspid aortic valve; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezaa149
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: The aim of this study was to evaluate whether additional cusp interventions and valve types affect aortic valve-related reoperation and mortality rates after the David procedure. METHODS: Between 1997 and 2018, a total of 449 patients {372 males; mean age 54.2 [standard deviation (SD) 15.2] years, range: 12.7–79.9 years} underwent elective valve-sparing aortic root replacement (David procedure) for aortic regurgitation and were prospectively followed up clinically and echocardiographically. RESULTS: The follow-up was 94% complete. Cumulative follow-up time was 2268 patient-years [mean follow-up time 5.1 (4.3 SD) years]. Thirty-day mortality was 2.2% ( n = 10). Late (>30 days) survival did not differ from that of the age- and gender-matched general population. Freedom from reoperation in patients without additional cusp reconstruction was 94% [95% confidence interval (CI) 91–98] and 92% (95% CI 88–97) at 5 and 10 years, respectively, which was not significantly different ( P = 1) for patients who did require additional cusp reconstruction 98% (95% CI 95–100) and 89% (95% CI 81–99). In patients with tricuspid aortic valves ( n = 338), freedom from reoperation was 96% (95% CI 94–99) and 93% (95% CI 88–97) at 5 and 10 years, respectively. Patients with bicuspid aortic valves ( n = 111) had a freedom from reoperation of 94% (95% CI 89–99) at 5 years and 88% (95% CI 79–98) at 10 years ( P = 0.021 for the comparison to tricuspid aortic valve). Overall, 23 patients (5%; 1%/patient-year) required reoperation with a mean interval of 4.5 (4.8 SD) months. CONCLUSIONS: The David procedure revealed low mid-term reoperation risk and excellent survival independent of adjunctive cusp interventions/valve morphology and is comparable with that of the age- and gender-matched general population.