Document Detail

Early results of valve-sparing aortic root replacement in high-risk clinical scenarios.
MedLine Citation:
PMID:  20103323     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The feasibility of valve-sparing aortic root procedures (David) in certain high-risk situations has been questioned. We sought to determine the safety of the David procedure in the following high-risk subgroups: acute type A dissection, severe aortic insufficiency (AI), and reoperations. METHODS: From 2005 through 2007, 110 root replacements were performed for the above criteria: 73 root replacements with a composite valve-conduit (Bentall) and 37 David procedures. The reimplantation technique was used in all 37 David patients, with 7 requiring aortic cusp repair. RESULTS: There were no significant differences in preoperative or intraoperative variables between the groups, with the exception of cross-clamp time, which was longer for David patients. There was a slight, but nonsignificant increase in mortality among Bentall patients (8.2% [6 of 73]) compared with David patients (5.4% [2 of 37], p = 0.59]. There were no differences with respect to postoperative stroke, renal failure, or respiratory failure. Predischarge echocardiogram in the surviving 35 David patients demonstrated no AI in 25 patients and trace/mild AI in 10. Freedom from AVR at a mean follow-up of 8.8 months (range, 1 to 40) was 94.3% (33 of 35). One patient required AVR because of endocarditis at 9 months, and 1 had severe AI 13 months postoperatively. CONCLUSIONS: Valve-sparing aortic root replacement can be performed safely in the setting of acute dissection, severe AI, and reoperations with acceptable early results. Long-term follow-up is needed to determine the durability of repair in these high-risk groups.
Faraz Kerendi; Robert A Guyton; J David Vega; Patrick D Kilgo; Edward P Chen
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  89     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-27     Completed Date:  2010-02-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  471-6; discussion 477-8     Citation Subset:  AIM; IM    
Copyright Information:
2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Cardiothoracic and Vascular Surgeons, Austin, Texas, USA.
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MeSH Terms
Aneurysm, Dissecting / diagnosis,  mortality,  surgery*
Aorta / surgery
Aortic Aneurysm, Thoracic / diagnosis,  mortality,  surgery*
Aortic Valve / surgery
Aortic Valve Insufficiency / diagnosis,  mortality,  surgery*
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation*
Follow-Up Studies
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation*
Kaplan-Meiers Estimate
Middle Aged
Polyethylene Terephthalates
Postoperative Complications / diagnosis,  mortality,  surgery
Prosthesis Design
Risk Factors
Survival Rate
Reg. No./Substance:
0/Polyethylene Terephthalates

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