title: David operation: single center 10-year experience.
abstract: OBJECTIVE
  Aortic valve-sparing operation has been progressively widely performed for the treatment of aortic root aneurysm. Nowadays, this procedure has been proposed even in presence of a bicuspid aortic valve, severe aortic regurgitation or in primary aortic dissection repair. We present our ten-year experience focusing on mid-term echocardiographic follow-up.
  
  
  METHODS
  Between June 2002 and February 2012, 139 patients (mean age of 61±12 years) underwent aortic valve-sparing operation with valve reimplantation. Twenty-seven patients (19%) had bicuspid aortic valve; in eighteen cases (13%) cusp motion or anatomical abnormalities concurred in determining aortic regurgitation and needed an adjunct cusp repair. A Gelweave Valsalva™ graft was implanted in all the patients.
  
  
  RESULTS
  The mortality pre-discharge was 0.7% (1 patient). The cumulative 1-year, 5-years and 8-years survival rates were 99%, 93% and 87% respectively. Postoperative aortic regurgitation more than mild degree (>2+/4+) was the only significant risk factors for redo aortic valve surgery Freedom from reoperation due to aortic valve regurgitation was 96% at 1 year, 90% at 5 years and 86% at 8 years. When comparing freedom from reoperation in patients with bicuspid vs tricuspid aortic valve, no differences were found (P=0.31) and the rate of aortic valve reoperation was significantly higher (P<0.001) in patients who received leaflet's repair.
  
  
  CONCLUSIONS
  The durability of valve reimplantation was found to be excellent in patients with tricuspid aortic valve and normal or nearly normal cusps. Cusp prolapse and complication after cusp repair turned out to be the main causes for early failure.
authors.affiliation: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy - pmalvin@tin.it.
authors.forename: P G
authors.initials: PG
authors.lastname: Malvindi
authors.forename: A
authors.initials: A
authors.lastname: Cappai
authors.forename: A
authors.initials: A
authors.lastname: Basciu
authors.forename: G M
authors.initials: GM
authors.lastname: Raffa
authors.forename: A
authors.initials: A
authors.lastname: Barbone
authors.forename: E
authors.initials: E
authors.lastname: Citterio
authors.forename: D
authors.initials: D
authors.lastname: Ornaghi
authors.forename: G
authors.initials: G
authors.lastname: Tarelli
authors.forename: F
authors.initials: F
authors.lastname: Settepani
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D012092:Replantation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome