Thorac cardiovasc Surg
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 Monsefi1, Petar Risteski1, Aleksandra Miskovic1, Anton Moritz1, Andreas Zierer2
  • 1Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt, Germany
  • 2Department of Thoracic and Cardiovascular Surgery, Heart Center Siegburg, Siegburg, Germany
Further Information

Publication History

25 December 2016

20 April 2017

Publication Date:
05 June 2017 (eFirst)

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.