Thorac Cardiovasc Surg 2013; 61 - SC118
DOI: 10.1055/s-0032-1332616

Superiority of 'David' reconstruction of the aortic root over conduit replacements in a consecutive series of 112 patients

P Schurr 1, A Blehm 1, I Zianika 1, H Kamiya 1, P Akhyari 1, A Albert 1, A Lichtenberg 1
  • 1Universitätsklinikum Düsseldorf, Kardiovaskuläre Chirurgie, Düsseldorf, Germany

Objectives: To study the outcome of valve-preserving 'David' reconstruction (DR) and valve-replacing aortic root surgery (VRAR).

Methods: 112 patients were included between February 2009 and November 2010. Preoperative risk, peri-operative morbidity and follow-up were recorded. Diagnoses included type A dissections, aneurysms, annular dilatations, and stenoses below 20 mm requiring root replacement. Intact aortic valves were preserved with DR.

Results: Surgeries included DR (n = 47) and VRAR with Medtronic freestyle valves (n = 34) and biological or mechanical conduits (n = 31). 49 patients (16 ascending aortas, 33 hemiarch and total arch replacements) underwent circulatory arrest for open distal anastomosis with selective cerebral perfusion (table). Flow velocities were significantly lower in patients after 'David' reconstruction. I° degree postoperative insufficiency was observed in 11 patients. After 17 months of median follow-up, 92 patients were alive (82.1%). Acute type A dissections, surgeries with circulatory arrest, hemiarch or total arch replacement and higher Euroscores negatively affected survival in Kaplan-Meier-analysis. Although time-consuming, DR conferred slightly better outcome when compared to VRAR, also in operations requiring circulatory arrest (mean survival 26.6 months versus 21.5 months, log-rank test p = 0.48, figure).

Table 1: Patient characteristics

*T-test, **Chi-squ. Test

Total No. of Patients (men/women)

112 (72/40)

p value

Age, years (mean ± sd)

64.1 ± 12.4

'David' Procedures, n = 47

Full root replacements n = 65

EUROSCORE II (EACTS 2011), mean ± sd

10.8 ± 10.8

12.9 ± 15.3

n.s. *

Replacement of aortic arch (hemiarch, total arch) including circulatory arrest, No. (%)

24 (51%)

9 (14%)

< 0.01**

Acute Type-A-dissection, No. (%)

17 (36%)

12 (18%)

0.049**

Postoperative Vmax over the valve, mean ± sd (m/s)

1.67 ± 0.4

2.87 ± 1.3

< 0.01*

Postoperative I° (and II°) aortic insufficiency

11 (2)

none

< 0.01**

Fig. 1: Overall survival in patients undergoing aortic surgery with circulatory arrest

Conclusion: DR offers advantages in hemodynamics and does not negatively affect outcome in complex aortic root surgery.