title: Long-term results after aortic valve-sparing operation (David I).
abstract: OBJECTIVE
  Aortic valve-sparing David procedure has gained broad acceptance. However, few long-term results have been published. We present our results.
  
  
  METHODS
  More than 450 David procedures have been performed in our institution so far. Of these, 126 patients were operated between July 1993 and December 2000. Median age was 57 (8-83) years and 46 (36.5%) were female. As many as 26 (20.6%) had Marfan syndrome, 21 (16.7%) had acute aortic dissection type A (AADA) and 67 (53.2%) had additional procedures.
  
  
  RESULTS
  There were six (4.8%) deaths in 30 post-operative period (POD), four of whom had AADA. In the follow-up, there were 32 (25.4%) late deaths, 11 (34.4%) of these were caused by cardiac or underlying disease or op-related. As many as 15 (11.9%) patients were re-operated; six (40%) were Marfan patients and two (13.3%) had early endocarditis. Follow-up echocardiography of 76 (60.3%) event-free patients showed valve insufficiency (AI)≤AI I° in 68 (89.5%) and grade II in 7 (9.2%) patients. Leaflet degeneration due to proposed leaflet contact with the straight Dacron graft was not observed. A total of 36 (47.4%) patients were in New York Heart Association (NYHA) class I, 33 (43.4%) in NYHA II, and five (6.6%) were in class III. During the entire follow-up of 790 patient-years, there was no stroke or major bleeding. Survival at 1, 5 and 10 years was 93%, 85% and 70%, respectively. Freedom from valve replacement at 1, 5 and 10 years was 96%, 91% and 87%, respectively.
  
  
  CONCLUSIONS
  Regardless of the underlying pathology, valve-sparing David I procedure has acceptable long-term results. Valve-related complications such as stroke or major bleeding is exceedingly low.
authors.affiliation: Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. shrestha.malakh.lal@mh-hannover.de
authors.forename: Malakh
authors.initials: M
authors.lastname: Shrestha
authors.forename: Hassina
authors.initials: H
authors.lastname: Baraki
authors.forename: Ilona
authors.initials: I
authors.lastname: Maeding
authors.forename: Sebastian
authors.initials: S
authors.lastname: Fitzner
authors.forename: Samir
authors.initials: S
authors.lastname: Sarikouch
authors.forename: Nawid
authors.initials: N
authors.lastname: Khaladj
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery; D001011:Aorta / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008382:Marfan Syndrome / Q000601:surgery; D008875:Middle Aged; D012086:Reoperation; D016896:Treatment Outcome; D055815:Young Adult