title: Comparison of David V valve-sparing root replacement and bioprosthetic valve conduit for aortic root aneurysm.
abstract: OBJECTIVE
  Valve sparing root replacement (VSRR) is an attractive option for the management of aortic root aneurysms with a normal native aortic valve. Therefore, we reviewed our experience with a modification of the David V VSRR and compared it with stented pericardial bioprosthetic valve conduit (BVC) root replacement in an age-matched cohort of older patients.
  
  
  METHODS
  A total of 48 VSRRs were performed at our institution, excluding those on bicuspid aortic valves. We compared these cases with 15 aortic root replacements performed using a BVC during the same period. Subgroup analysis was performed comparing 16 VSRR cases and 15 age-matched BVC cases.
  
  
  RESULTS
  The greatest disparity between the VSRR and BVC groups was age (53 vs 69 years, respectively; P < .0005). The matched patients were similar in terms of baseline demographics and differed only in concomitant coronary artery bypass grafting (2 VSRR vs 7 BVC patients; P = .036). None of the VSRR and 3 of the BVC procedures were performed for associated dissection (P = .101). Postoperative aortic insufficiency grade was significantly different between the 2 groups (P = .004). The cardiopulmonary bypass, crossclamp, and circulatory arrest times were not different between the VSRR and BVC groups (174 vs 187 minutes, P = .205; 128 vs 133 minutes, P = .376; and 10 vs 13 minutes, respectively; P = .175). No differences were found between the 2 groups with respect to postoperative complications. One postoperative death occurred in the BVC group and none in the VSRR group. The postoperative length of stay and aortic valve gradients were less in the VSRR group (6 vs 8 days, P = .038; 6 vs 11.4 mm Hg, P = .001). The intensive care unit length of stay was significantly less in the VSRR group (54 vs 110 hours, P = .001).
  
  
  CONCLUSIONS
  VSRR is an effective alternative to the BVC for aortic root aneurysm.
authors.affiliation: Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Walter F
authors.initials: WF
authors.lastname: DeNino
authors.affiliation: Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: John Matthew
authors.initials: JM
authors.lastname: Toole
authors.affiliation: Department of Cardiology, Medical University of South Carolina, Charleston, SC.
authors.forename: Christopher
authors.initials: C
authors.lastname: Rowley
authors.affiliation: Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Martha R
authors.initials: MR
authors.lastname: Stroud
authors.affiliation: Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC. Electronic address: ikonomij@musc.edu.
authors.forename: John S
authors.initials: JS
authors.lastname: Ikonomidis
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D002315:Cardiopulmonary Bypass; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011474:Prosthesis Design; D012189:Retrospective Studies; D013022:South Carolina; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult