ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2019 April;60(2):259-67

DOI: 10.23736/S0021-9509.18.10690-2

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Modified sizing technique with newly designed tools to facilitate the valve sparing aortic root replacement “David” procedure with mid-term results

Sharaf-Eldin SHEHADA ¹ ✉, Jaroslav BENEDIK ², Maria SERRANO ¹, Juri LURBASKI ¹, Ender DEMIRCIOGLU ¹, Daniel WENDT ¹, Heinz JAKOB ¹, Fanar MOURAD ¹

¹ Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany; ² Department of Cardiovascular Surgery, Helios Clinic Krefeld, Krefeld, Germany

BACKGROUND: Valve sparing root replacement differs in specific points. The main target remains to achieve a perfect intraoperative result and long-term stability. We aimed in this study to present our modified sizing technique for valve-sparing “David” procedure and its mid-term results.
METHODS: We present a retrospective single-center study. A newly designed sizing ring in addition to triple-armed forceps (Trifeet®) was used to measure the proper size of the Valsalva® prosthesis for patients undergoing David-procedure. Primary endpoints are intraoperative aortic regurgitation (AR) and early postoperative outcomes. Secondary endpoints included freedom from aortic regurgitation or reoperation and overall mortality.
RESULTS: A total of 63 consecutive patients who underwent David procedure between 09/2012 and 12/2016 were evaluated. Mean age was 52±15 years and 76.2% were male. Moderate to severe aortic regurgitation was reported in 60 (95.2%) patients. Four (6.3%) patients presented with type-A aortic dissection, 20 (31.7%) patients had bicuspid and 3 (4.8%) had a unicuspid aortic valve, 2 (3.2%) patients had a prior aortic valve repair. Intraoperative echocardiography revealed no 34 (54%), trace 26 (41.2%) or moderate 3 (4.8%) AR. Stroke, myocardial infarction, and 30-day mortality occurred in 1 patient (1.6%). During follow-up 5 (7.9%) patients needed reoperation due to recurrent AR within a mean of 35±18 months. One could be re-repaired, and the other four underwent aortic valve replacement. A second patient died in the late follow-up.
CONCLUSIONS: Our modified sizing technique simplifies the “David-procedure” and allows to achieve a good intraoperative and mid-term results. However, these results have to be confirmed in a larger cohort with a long-term follow-up.

KEY WORDS: Heart valve prosthesis implantation - Follow-up studies - Cardiac surgical procedures