Successful midterm results of aortic valve repair in patients with typ A aortic dissection using the David-technique

Valve-sparing aortic root surgery has gained considerable interest in the last few years. The indication for patients with aortic dissection however is still discussed controversially.

Thirty three pts were operated using the valve reimplantation procedure of David (58±16 y, 24 male, EuroScore 8±3). Pts of group A showed aortic dissection (n=7), while pts of group B had ascending aortic aneurysm (n=26) as underlying pathology. Group A pts had a higher EuroScore (12±3 vs. 7±2, p<0.001), a higher female/male-ratio (1.3 vs. 0.19, p<0.001) and a lower ECC temperature (24±5 vs. 29±4°C, p=0.005) compared to group B pts. Additional cusp manoeuvres were performed in 1 pt of group A but in 17 pts of group B (Trussler plasty 10, cusp shortening 8, decalcification 3). All other demographic or operative parameters were comparable.

One patient of group B died on the sixth postoperative day after intestinal perforation. All other patients (97%) are alive without complications after a follow-up of 15±14 months (max 60). Postoperative echocardiographic examination revealed no aortic regurgitation in 24 pts (57% vs. 77%) and a mild reflux in 9 pts (43% vs. 23%). A slight progressive aortic regurgitation during the follow-up was observed in only one patient of group A without LV-enlargement after 20 months. No valve related re-operation or thrombembolic events were noticed.

The David procedure resulted in excellent midterm results even in patients with ascending aortic dissection. The application of this technique seems justified as an alternative to the conventional French glue reconstruction or Conduit-implantation.