Thorac cardiovasc Surg
DOI: 10.1055/s-0039-1693654
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Aortic Valve–Sparing Root Replacement (David I Procedure) in Adolescents: Long-Term Outcome

Erik Beckmann
1  Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Andreas Martens
1  Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Heike Krueger
1  Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Wilhelm Korte
1  Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Tim Kaufeld
1  Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Axel Haverich
1  Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Malakh Lal Shrestha
1  Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
› Author Affiliations
Funding This study was funded by departmental grants.
Further Information

Publication History

14 March 2019

10 June 2019

Publication Date:
22 July 2019 (online)

Abstract

Introduction Aortic valve-sparing root replacement (David's procedure) is an especially appealing treatment option for young patients. Here, we present the short-, mid, and long-term outcomes of this operation in adolescent patients.

Methods Between September 1994 and March 2014, 29 patients aged 6 to 21 years underwent the 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's syndrome was present in 86% (n = 25) of cases. Ninety-seven percent (n = 28) of cases were performed electively, and one case (3%) was performed emergently for acute aortic dissection type A. There were no early perioperative deaths (0%). Follow-up, which was completed on 100% of patients, comprised a total of 394 patient years and a mean follow-up time of 13.6 ± 5.4 years. The estimates for survival at 1, 5, and 10 years after initial surgery were 100, 97, and 93%, respectively. During follow-up, there were four (14%) late deaths and five (17%) aortic valve-related reoperations. The 1-, 5-, and 10-year estimates for freedom from valve-related reoperation were 100, 86, and 83%, respectively. The perioperative mortality for these five reoperations was 0%.

Discussion Aortic valve–sparing root replacement can be performed in adolescents with a very low perioperative risk. Long-term survival seems to be affected by connective tissue diseases.

Note

The manuscript has been selected for presentation at the Annual Meeting of the German Society for Thoracic, Cardiac and Vascular Surgery in Wiesbaden, Germany, February 16 to 19, 2019.