title: Long-Term Results after Aortic Valve-Sparing-Reimplantation Operation (David) in Bicuspid Aortic Valve.
abstract: OBJECTIVE
  The aortic valve-sparing reimplantation operation (David) is increasingly used in patients with aortic root aneurysm and intact cusps. David's procedure is also feasible in patients with bicuspid aortic valve (BA), though few long-term data are available.
  
  
  METHODS
  An analysis was conducted of the long-term echocardiographic data from patients with BAV who had undergone David's procedure at early and long-term follow up (FU) examinations.
  
  
  RESULTS
  Between 1994 and 2010, a total of 30 patients with BAV underwent David's procedure at the authors'institution. There were no in-hospital or late deaths, and the mean long-term FU was 6.64 ± 3.54 years (range: 3.2-20.1 years). The mean aortic regurgitation (AR) grade was increased from 0.26 ± 0.37 at early FU to 0.70 ± 0.80 at long-term FU (p = 0.013). Four patients (13%) had to be reoperated after 10.00 ± 4.74 years (range: 5.49-17.06 years) due to aortic stenosis (n = 1) and aortic insufficiency (n = 3); the latter three patients had a significant prolapse of both the fused and the non-coronary cusp of reconstruction.
  
  
  CONCLUSIONS
  The mean AR grade was increased significantly but was ≤ I-II in 59% of patients and ≤ II in 93% of patients after a mean FU of 6.6 years. Patients with prolapsing non-coronary leaflet at reconstruction seemed vulnerable to recurrent AR. Among patients, survival was excellent, and the reoperation rate and hemodynamics acceptable. Long-term follow up data are necessary to further refine the surgical techniques employed and to improve the results achieved.
authors.forename: Doreen
authors.initials: D
authors.lastname: Richardt
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stierle
authors.forename: Hans-Hinrich
authors.initials: HH
authors.lastname: Sievers
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001023:Aortic Valve Prolapse / Q000209:etiology / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D005260:Female; D005858:Germany; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012092:Replantation / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography