Thorac Cardiovasc Surg 2018; 66(04): 301-306
DOI: 10.1055/s-0037-1603495
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Midterm Results of a Minimally Invasive Approach in David Procedure

Nadejda Monsefi
1   Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt, Germany
,
Petar Risteski
1   Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt, Germany
,
Aleksandra Miskovic
1   Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt, Germany
,
Anton Moritz
1   Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt, Germany
,
Andreas Zierer
2   Department of Thoracic and Cardiovascular Surgery, Heart Center Siegburg, Siegburg, Germany
› Author Affiliations
Further Information

Publication History

25 December 2016

20 April 2017

Publication Date:
05 June 2017 (online)

Abstract

Background The David procedure is a well-known technique in selected patients with aortic root pathology. A minimally invasive approach in heart surgery increases open interest.

Methods From 1991 to 2015, the David technique was performed in 296 patients in our unit. In 90 cases, operations were performed through partial upper sternotomy. The patient mean age was 57 ± 14 years in the minimally invasive group (n = 90) and 58 ± 14 years in the complete sternotomy group (n = 206; p = 0.2). The neosinus modification was performed in 80 patients (89%) in the minimally invasive group and in 79 patients (38%) in the complete sternotomy group (p < 0.01). Mean follow-up was 3 ± 2 years in the minimally invasive group and 8 ± 4 years in the complete sternotomy group.

Results Thirty-day mortality was zero in the minimally invasive group and was 3% (n = 6) in the complete sternotomy group (p = 0.1). The need for packed red blood cells was significantly lower in the minimally invasive group (1.6 ± 3 U) than in the complete sternotomy group (3.7 ± 6 U; p < 0.01). Thirty late deaths (2% per patient-year) were observed in the complete sternotomy group versus zero in the minimally invasive group (p < 0.01). One patient (0.5% per patient-year) in the minimally invasive group and 12 patients (0.8% per patient-year) in the complete sternotomy group required reoperation in the follow-up period (p = 0.05).

Conclusions Minimally invasive David technique for patients with ascending aortic aneurysm and aortic valve insufficiency offers a good solution with low perioperative blood transfusion rate. Our midterm results show low valve-related complications and reoperation rate. However, long-term follow-up of the minimally invasive group is necessary.

Note

This abstract was published in similar form at the DGTHG annual meeting in Leipzig in 2016.


 
  • References

  • 1 Bonacchi M, Prifti E, Giunti G, Frati G, Sani G. Does ministernotomy improve postoperative outcome in aortic valve operation? A prospective randomized study. Ann Thorac Surg 2002; 73 (02) 460-465 , discussion 465–466
  • 2 Bakir I, Casselman FP, Wellens F. , et al. Minimally invasive versus standard approach aortic valve replacement: a study in 506 patients. Ann Thorac Surg 2006; 81 (05) 1599-1604
  • 3 Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax 1968; 23 (04) 338-339
  • 4 Yacoub MH, Gehle P, Chandrasekaran V, Birks EJ, Child A, Radley-Smith R. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg 1998; 115 (05) 1080-1090
  • 5 David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg 1992; 103 (04) 617-621 , discussion 622
  • 6 Zierer A, Aybek T, Risteski P, Dogan S, Wimmer-Greinecker G, Moritz A. Moderate hypothermia (30°C) for surgery of acute type A aortic dissection. Thorac Cardiovasc Surg 2005; 53 (02) 74-79
  • 7 Zierer A, Detho F, Dzemali O, Aybek T, Moritz A, Bakhtiary F. Antegrade cerebral perfusion with mild hypothermia for aortic arch replacement: single-center experience in 245 consecutive patients. Ann Thorac Surg 2011; 91 (06) 1868-1873
  • 8 Aybek T, Sotiriou M, Wöhleke T. , et al. Valve opening and closing dynamics after different aortic valve-sparing operations. J Heart Valve Dis 2005; 14 (01) 114-120
  • 9 Bakhtiary F, Monsefi N, Herrmann E. , et al. Long-term results and cusp dynamics after aortic valve resuspension for aortic root aneurysms. Ann Thorac Surg 2011; 91 (02) 478-484
  • 10 Moritz A, Risteski P, Dogan S. , et al. Six stitches to create a neosinus in David-type aortic root resuspension. J Thorac Cardiovasc Surg 2007; 133 (02) 560-562
  • 11 Monsefi N, Zierer A, Risteski P. , et al. Long-term results of aortic valve resuspension in patients with aortic valve insufficiency and aortic root aneurysm. Interact Cardiovasc Thorac Surg 2014; 18 (04) 432-437
  • 12 Monsefi N, Bakhtiary F, Moritz A. Supra-annular stitch to avoid distortion of the right coronary cusp in aortic root resuspension. J Heart Valve Dis 2010; 19 (03) 371-373
  • 13 Mihaljevic T, Cohn LH, Unic D, Aranki SF, Couper GS, Byrne JG. One thousand minimally invasive valve operations: early and late results. Ann Surg 2004; 240 (03) 529-534 , discussion 534
  • 14 Yan TD. Mini-Bentall procedure and hemi-arch replacement. Ann Cardiothorac Surg 2015; 4 (02) 208-209
  • 15 Shrestha M, Krueger H, Umminger J. , et al. Minimally invasive valve sparing aortic root replacement (David procedure) is safe. Ann Cardiothorac Surg 2015; 4 (02) 148-153
  • 16 Johnston DR, Roselli EE. Minimally invasive aortic valve surgery: Cleveland Clinic experience. Ann Cardiothorac Surg 2015; 4 (02) 140-147
  • 17 Leontyev S, Trommer C, Subramanian S. , et al. The outcome after aortic valve-sparing (David) operation in 179 patients: a single-centre experience. Eur J Cardiothorac Surg 2012; 42 (02) 261-266 , discussion 266–267
  • 18 Fröschle GW, Kiraly Z, Broelsch CE. Cholecystectomy by mini-laparotomy with the Jako retractor system [in German]. Langenbecks Arch Chir 1997; 382 (05) 274-276