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CC BY-NC-ND 4.0 · Aorta (Stamford) 2023; 11(03): 097-106
DOI: 10.1055/s-0043-1768968
Original Research Article

Reoperation or Aortic Regurgitation Progression after Reimplantation of the Aortic Valve (David's Procedure) Using the Valsalva Graft

Authors

  • Kristina Ma

    1   Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden

  • Emelie Carlestål

    1   Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
    2   Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden

  • Anders Franco-Cereceda

    1   Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
    2   Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden

  • Christian Olsson 

    1   Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
    2   Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden

Funding This study was funded by donations from Mr. Fredrik Lundberg (A.F-C., C.O.) and from the Schörling Foundation (C.O.)
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Abstract

Background This study aimed to assess predictors of a composite endpoint (reoperation for aortic valve [AV] failure or aortic regurgitation [AR] grade ≥ 2) after reimplantation of the aortic valve (RAV) using the Valsalva graft.

Methods From 2012 to 2021, 112 patients underwent RAV in a single center. Clinical and echocardiographic data were collected retrospectively. Cox regression analysis was used to identify predictors of the composite endpoint. Kaplan–Meier methods were used for time-to-event analysis.

Results Median (interquartile range) age was 52 years (44, 62). Nineteen patients (17%) were operated for acute Type A aortic dissection, and the remainder for aortic root aneurysm, 60 mm or larger in 12/112 (11%). Thirty-day mortality was 1/112 (1%). During follow-up, four patients (3.6%) were reoperated for AV failure, and another nine patients (8.1%) developed AR grade ≥ 2. Overall estimated freedom from reoperation or AR grade ≥ 2 was 87% (95% confidence interval: 76–93%) at 5 years. Significantly lower estimated 5-year freedom from the composite endpoint was found in cases with simultaneous aortic valve repair (AVr; 77 vs. 90%, p = 0.007) and nearly significant for large (≥ 6 cm) aortic root diameter (82 vs. 87%, p = 0.055). In Cox's analysis, aortic root diameter and simultaneous AVr were independent predictors for the composite endpoint.

Conclusion Outcomes (survival, reoperation, freedom from AR grade ≥ 2) with RAV were good up to 11-year follow-up. Larger aortic root diameter and simultaneous AVr were identified as predictors for reoperation or AR grade ≥ 2. Long-term follow-up remains necessary to confirm adequate AV function.

Keywords

reimplantation of the aortic valve - valve-sparing root replacement - aortic valve reimplantation - David procedure

Authors Contributions

Concept/design: E.C., A.F-C., C.O.; data collection: K.M., C.O.; data analysis/interpretation: K.M., E.C., A.F-C., C.O.; Statistics: K.M., C.O.; drafting article: K.M., C.O.; critical revision: K.M., E.C., A.F-C., C.O.; approval: KM, E.C., A.F-C., CO; funding: A.F-C., C.O.


Ethics and Integrity Policies Statements

All procedures performed in studies involving human participants were in accordance with 1964 Helsinki declaration and its later amendments or comparable ethical standards.


Institutional Review Board Approval or Waiver

This study was approved by the institutional review board (no. 2021-05562)


Supplementary Material



Publication History

Received: 23 August 2022

Accepted: 07 April 2023

Article published online:
24 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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