Elective David I Procedure Has Excellent Long-Term Results: 20-Year Single-Center Experience

Abstract

Background: We present our results after elective, isolated David I procedures over the past 20 years.

Methods: Between 1993 and 2015, 197 patients (mean age 46 ± 17 years, 73% men) underwent isolated aortic valve reimplantation using straight tube grafts (David I procedure). Sixty patients (31%) had Marfan syndrome, and 24 (12%) had a bicuspid aortic valve. Twenty-four patients (12%) were operated through upper mini-sternotomy.

Results: There were no perioperative deaths. Stroke rate was 1% (2 of 197). Discharge echocardiography showed none to trivial aortic regurgitation (AR) in 71% (139 of 197 patients) and mild AR in 26% (51 of 197 patients). Thirty-two patients (16%) died during follow-up (9.0 ± 5.5 years after operation). One death was aortic valve related. Twenty-six patients (13%) underwent aortic valve reoperations during follow-up (5.5 ± 5.0 years after operation). Late endocarditis occurred in 2 patients (1.0%). More than trivial AR at discharge predicted a higher reoperation rate. In 144 non-reoperated survivors, echocardiography showed none to trivial AR in 56 (39%), mild AR in 53 (37%), moderate AR in 19 (6.3%), and severe AR in 4 (2.7%) of the patients after 12 ± 5.3 years.

Conclusions: The valve-sparing David I procedure has excellent short- and long-term results. Erosion due to supposed leaflet contact with the straight tube graft was not observed in any patient, proving that using a straight graft has no negative impact on the leaflets. The "spared valve" (being native living tissue) seems to be more resistant to infection than prosthetic valves.