Early results of valve-sparing aortic root replacement in high-risk clinical scenarios.
BACKGROUND
The feasibility of valve-sparing aortic root procedures (David) in certain high-risk situations has been questioned. We sought to determine the safety of the David procedure in the following high-risk subgroups: acute type A dissection, severe aortic insufficiency (AI), and reoperations.


METHODS
From 2005 through 2007, 110 root replacements were performed for the above criteria: 73 root replacements with a composite valve-conduit (Bentall) and 37 David procedures. The reimplantation technique was used in all 37 David patients, with 7 requiring aortic cusp repair.


RESULTS
There were no significant differences in preoperative or intraoperative variables between the groups, with the exception of cross-clamp time, which was longer for David patients. There was a slight, but nonsignificant increase in mortality among Bentall patients (8.2% [6 of 73]) compared with David patients (5.4% [2 of 37], p = 0.59]. There were no differences with respect to postoperative stroke, renal failure, or respiratory failure. Predischarge echocardiogram in the surviving 35 David patients demonstrated no AI in 25 patients and trace/mild AI in 10. Freedom from AVR at a mean follow-up of 8.8 months (range, 1 to 40) was 94.3% (33 of 35). One patient required AVR because of endocarditis at 9 months, and 1 had severe AI 13 months postoperatively.


CONCLUSIONS
Valve-sparing aortic root replacement can be performed safely in the setting of acute dissection, severe AI, and reoperations with acceptable early results. Long-term follow-up is needed to determine the durability of repair in these high-risk groups.
Kerendi
Faraz
F
Cardiothoracic and Vascular Surgeons, Austin, Texas, USA.
Guyton
Robert A
RA
Vega
J David
JD
Kilgo
Patrick D
PD
Chen
Edward P
EP
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate
D011093:Polyethylene Terephthalates