Aortic Valve-Sparing Root Replacement (David I Procedure) in Pediatric Patients: Midterm Outcome

Introduction: Aortic valve-sparing root replacement (David procedure) is an especially appealing treatment option for children. Here, we present the short- and mid-term outcome with this technique in pediatric patients.

Methods: Between September 1994 and March 2014, twenty-nine patients under the age of 21 years underwent David-I procedure at our center. We conducted a retrospective study with follow-up.

Results: The mean age was 16.8 ± 3.4 years and 90% (n = 26) were male. Marfan syndrome was present in 86% (n = 25) of cases. 97% (n = 28) of cases were performed electively, and 1 case (3%) was performed emergently for acute aortic dissection type A. 10% of cases had history of previous cardiac surgery. Concomitant cardiac procedures were performed in 21% (n = 6). There was no early perioperative death (0%). We performed a follow-up with a mean follow-up time of 8.9±5.7 years. During follow-up, there were 4 (14%) late deaths and 4 (14%) aortic valve-related reoperations. Of note, three of these reoperations were performed in patients who underwent David procedure shortly after the technique was introduced at our institution.

Discussions: Aortic valve-sparing root replacement can be performed in pediatric patients with a very low perioperative risk. Midterm performance of the aortic valve repair seems to follow a learning curve, as three of four reoperations were done in patients who underwent initial surgery within the early learning phase.