Long-term results of the David Procedure in patients with acute type A aortic dissection

Introduction: The David Procedure may provide an attractive alternative to aortic root replacement in patients with aortic valve insufficiency (AI) even in the emergency setting of an acute type A aortic dissection (AAD). Methods: From 1996 to 2011 the David Procedure was performed in 23 patients with AAD in our department. Patients' mean age was 49 +/- 15 years and 70% (n = 16) were male. Concomitant hemiarch replacement was performed in 19 patients while the remaining 4 patients underwent full arch replacement. Additional leaflet prolapse was corrected by plication in 5 cases. A modification of the classic David technique was performed by creating a pseudosinus in 6 patients (26%) and a neosinus in 9 patients (39%). Mean follow up was 7.7 +/- 3 years. Results: Thirty-day mortality was zero. There were 4 late deaths (17%). One patient suffered a perioperative neurologic event (4%). One further patient suffered a late stroke during follow up (0.6%/pt-yr). Three patients (1.7%/pt-yr) required aortic valve reoperation during follow up: in 2 cases leaflet perforation was observed, and one patient had to undergo valve replacement because of endocarditis with severe AI. There were two cases of bleeding events (1.1%/pt-yr) at follow up. The linearized rate for recurrent AI >= 2 degrees was 1.1%/pt-yr. Discussion: The David Procedure certainly provides a challenging option to treat selected young patients with AI in the presence of AAD. However, current data suggest that it is safe and feasible. Conclusions: Long-term valve-related events of the David Procedure applied in emergency cases are rare and aortic valve function remains stable for many years. (C) 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.