Midterm follow-up dynamic echocardiography evaluation after ascending aorta replacement and reimplantation of the aortic valve (David operation) in a matched control study.
OBJECTIVE
Dynamic performance of the aortic valve (AV) after ascending aorta replacement with reimplantation of the native AV (David) was investigated.


METHODS
We prospectively evaluated 17 patients who underwent David procedure. Rest/stress echocardiography follow-up was performed and results were compared with those of matched healthy controls.


RESULTS
There were no significant differences in terms of age, height, weight, BSA, left ventricular mass, left ventricular ejection fraction (LVEF) and tele-diastolic volume between the David and control group. At rest echocardiography, patients in the David group had a lower indexed aortic valve area (IAVA) (1.1 ± 0.2 vs. 1.5 ± 0.2 cm(2)/m(2), P < 0.0001), with comparable transvalvular gradients (TVG). At maximal physical stress, although the IAVA in the David group was significantly increased from the rest values (P = 0.001), the difference with the control group persisted (David 1.4 ± 0.3 vs. Control 1.7 ± 0.2 cm(2)/m(2), P < 0.0001) maintaining similar peak TVG (David 13.6 ± 5.3 vs. Control 11.7 ± 4.5 mmHg, P = ns) and mean TVG (David 7.2 ± 3.0 vs. 6.2 ± 2.4 mmHg, P = ns). AV regurgitation in the David group was absent in five (29.4%), grade I in nine (52.9%) and grade II in three (17.6%) patients and remained unchanged during stress. At multiple linear regression, David operation was inversely correlated to rest IAVA (OR = -0.4; P = 0.01; CI: -0.7-0.1).


CONCLUSIONS
Although IAVA is significantly smaller after David procedure in comparison with matched controls, no pathological increase in TVG is noticed. A significant increase in the IAVA during physical stress documents the preserved pliability/elasticity of the aortic unit after David procedure preventing pathological increase in the TVG even during strenuous effort.
Department of CT Surgery, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy. gdancona@ismett.edu
Giuseppe
G
D'Ancona
Renato
R
Ciofalo
Domenico
D
Biondo
Marco
M
Follis
Fabrizio
F
Follis
D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000601:surgery*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D016022:Case-Control Studies; D025401:Echocardiography, Stress; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome