Document Detail

The David procedure in different valve pathologies: a single-center experience in 236 patients.
MedLine Citation:
PMID:  23063194     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Reports of the long-term outcome after the David procedure in different valve pathologies are limited. We compared our results in patients with tricuspid and bicuspid aortic valves, including those who required additional cusp repair.
METHODS: Between 1997 and 2011, 236 patients (76% males; mean age, 56 ± 15; range, 12 to 79 years) underwent valve-sparing aortic root replacement (David procedure) for aortic regurgitation and were prospectively followed up clinically and echocardiographically.
RESULTS: The follow-up was 94% complete. Cumulative follow-up time was 896 patient-years (mean follow-up time, 4.5 ± 2.7; range, 0.6 to 13.7 years). The 30-day mortality was 1.7% (4 of 236), and late mortality was 4% (10 of 232), with one cardiac-related death due to aortic valve regurgitation. Overall freedom from valve replacement was 94% and 87% at 5 and 10 years, respectively. In 201 patients with tricuspid aortic valves, freedom from reoperation was 94% and 90% at 5 and 10 years, respectively. This was comparable to the 53 patients with bicuspid aortic valves, with a freedom from reoperation of 97% at 5 years (p = 0.632). Forty-two patients (18%) required additional cusp repair and had a 100% freedom from reoperation at 5 years. Overall, 10 patients (4%) required reoperation, with a mean interval of 11.5 ± 10.7 months. Reasons for reoperation were recurrent aortic valve regurgitation grade II (n = 6), aortic stenosis (n = 2), endocarditis (n = 1), and a ruptured central plication (n = 1).
CONCLUSIONS: The David procedure revealed excellent long-term outcomes independently from the valve morphology. Rates of reoperations and valve-related morbidity were acceptably low. Additional cusp repair was no predictor for failure of this procedure.
Markus Liebrich; Marcin K Kruszynski; Detlev Roser; Christoph Meisner; Kai-Nicolas Doll; Wolfgang B Hemmer; Timo Weimar
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2012-10-11
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  95     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-31     Completed Date:  2013-02-26     Revised Date:  2013-11-07    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  71-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart, Stuttgart, Germany.
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MeSH Terms
Follow-Up Studies
Germany / epidemiology
Heart Valve Diseases / mortality,  surgery*
Heart Valve Prosthesis Implantation / methods*
Middle Aged
Reoperation / statistics & numerical data
Retrospective Studies
Risk Factors
Survival Rate / trends
Time Factors
Treatment Outcome
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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