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

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 ministernotomy. 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. (C) 2018 by The Society of Thoracic Surgeons