title: Quality of life after aortic root surgery: reimplantation technique versus composite replacement.
abstract: BACKGROUND
  Recent studies indicate the safety of the aortic valve reimplantation technique (David operation) in the long-term follow-up. The aim of this study was to compare the results of the David operation with those of the aortic composite replacement procedure, with the focus on quality of life (QoL).
  
  
  METHODS
  Within a 6-year period, 143 patients received either an aortic composite replacement (composite group, n = 67) or the David-I operation (David group, n = 76). The QoL of 108 patients (87% of the living patients) was evaluated postoperatively by the 36-Item Short Form Health Survey. A subgroup analysis of QoL excluded patients with aortic stenosis and type A acute aortic dissection.
  
  
  RESULTS
  Hospital survival rates (89.6% versus 97.4%, p = 0.102), as well as actuarial 1-year survival rate (86.6% versus 91.9%) and 3-year survival rate (81.1% versus 91.9%) proved more successful among the David group. Incidences of serious adverse events during the follow-up period (10.8% versus 28.3%, p = 0.008) were higher for patients of the composite group. The QoL was found to be compromised for patients of the composite group, in relation to all criteria outlined in the 36-Item Short Form Health Survey. Subgroup analysis without patients with dissection and aortic stenosis demonstrated a significantly better postoperative QoL for patients of the David group. Patients belonging to the composite group were more frequently compromised by prosthetic valve noise (p < 0.001).
  
  
  CONCLUSIONS
  This study demonstrates the superiority of the aortic valve reimplantation compared with the aortic composite replacement, regarding both clinical outcome and postoperative QoL.
authors.affiliation: Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany. ulrich.franke@rbk.de
authors.forename: Ulrich F W
authors.initials: UF
authors.lastname: Franke
authors.forename: Anne
authors.initials: A
authors.lastname: Isecke
authors.forename: Ragi
authors.initials: R
authors.lastname: Nagib
authors.forename: Martin
authors.initials: M
authors.lastname: Breuer
authors.forename: Jens
authors.initials: J
authors.lastname: Wippermann
authors.forename: Katharina
authors.initials: K
authors.lastname: Tigges-Limmer
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000401:mortality / Q000523:psychology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011788:Quality of Life; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D015996:Survival Rate