title: Long-Term Hemodynamic Performance of the Aortic Valve After David I: An Echocardiographic Study.
abstract: Despite optimal hemodynamics at rest, the performance of the aortic valve under stress conditions long after David I procedure is still debated. From 2001-2014, 73 patients underwent reimplantation with David I technique. Aortic valve function of 13 patients (age 61.2 ± 8.72) with a follow-up of at least 5 years (6.3 ± 0.9 years) was assessed at exercise echocardiographic stress test on a stationary cycle. Patients who had undergone concomitant procedure, with recurrent aortic insufficiency or mitral valve incompetence, were excluded. In all, 8 healthy volunteers served as controls. Transvalvular gradients progressively increased during the steps in both groups (P-within < 0.001), being higher in David patients (P-between < 0.001), but never reaching a clinical significance (David Peak gradient 23.8 ± 9.3 mmHg; Mean gradient 13.2 ± 5.1 mmHg). Effective orifice area (EOA) and EOA index did not change during the test in David patients, whereas Controls showed a progressive increase of functional valve area to a peak at 50 W (Controls EOA 4.0 ± 0.5 cm(2); EOA index 2.0 ± 0.3 cm(2)/m(2)). In conclusion, David I procedure ensures good hemodynamics during high-flow conditions at long-term follow-up. The reimplantation of the functional aortic annulus inside a rigid tube determines a paradoxical reduction of functional aortic valve area, secondary to the increased stroke volume, without any clinically relevant increase in transvalvular gradients. These data confirm the reliability of David I in the long term, even under physical stress conditions.
authors.affiliation: Cardiac Surgery Unit, AOU Policlinico-Vittorio Emanuele, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Mignosa
authors.affiliation: Cardiac Surgery Unit, AOU Policlinico-Vittorio Emanuele, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Mariani
authors.affiliation: Cardiology Unit, AOU Policlinico-Vittorio Emanuele, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Wanda
authors.initials: W
authors.lastname: Deste
authors.affiliation: Cardiology Unit, AORNAS Garibaldi, Catania, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Felis
authors.affiliation: Cardiac Surgery Unit, AOU Policlinico-Vittorio Emanuele, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Stefano
authors.affiliation: Cardiac Surgery Unit, AOU Policlinico-Vittorio Emanuele, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Giuffrida
authors.affiliation: Cardiac Surgery Unit, AOU Policlinico-Vittorio Emanuele, Ferrarotto Hospital, University of Catania, Catania, Italy. Electronic address: antonio.rubino@hotmail.com.
authors.forename: Antonino S
authors.initials: AS
authors.lastname: Rubino
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery*; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: aortic root; aortic valve repair; exercise echocardiography; reimplantation