Valve-sparing aortic root replacement

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Medical intervention

Valve-sparing aortic root replacement
Other names	David procedure
Specialty	Cardiology, cardiothoracic surgery
[edit on Wikidata]

Valve-sparing aortic root replacement (also known as the David procedure) is a cardiac surgery procedure which is used to treat Aortic aneurysms and to prevent Aortic dissection. It involves replacement of the aortic root without replacement of the aortic valve. Two similar procedures were developed, one by Sir Magdi Yacoub, and another by Tirone David.

Techniques

The valve-sparing aortic root replacement allows for direct narrowing of enlarged aortas, which change the fluid dynamics of outbound blood from the heart, while preserving the natural tissues of the aortic valve, which means the patient does not have to rely on anticoagulants. Common features of both techniques of the replacement process are the clamping of the aorta and the use of a length of Dacron tube (also known as an "aortic graft"), typically 5 cm, to constrict the aortic root to the normal diameter, while the patient is cooled to 20°C and placed on life support. The procedure typically takes 4 to 6 hours in healthy patients.

Re-modeling technique

Established by Sir Magdi Yacoub in the mid-1990s, the process involves cutting the aorta superior of (slightly downstream of) the aortic valve and attaching the tube, one end of which has been shaped into a three-lobed wavy ring, directly to the commissures connecting the aortic valve to the aortic wall. In other words, the "sinotubular junction" holding the aortic valve in place is reformed with the tube flush with the outermost valve tissue, and extending between the valve's cusps.

Re-implantation technique

Established by Tirone E. David and Christopher Feindel at the Toronto General Hospital in 2007, this technique differs in the shape of the Dacron tube's end, which here is a ring with a flat edge, and its location, with the sinotubular junction "inserted" into the tube. In other words, the tube acts like a "corset" on the outside of the wall surrounding the aortic valve, though the tube's attachment points are the same as in the Yacoub method.

Results

A 2023 literature review of David method patient outcomes after 2010 found that the chances of complications such as endocarditis and stroke, were reduced to 0.3%, while survival rates were 99% within a year and 89% within a decade afterward. The most common reason for follow-up (typically needed in 5 years) was minor chest bleeding, reported by 5.4% of patients.

References

^ "The Modified David's Reimplantation Procedure". clevelandclinic.org. Retrieved 15 July 2014.
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David, TE; David, CM; Ouzounian, M; Feindel, CM; Lafreniere-Roula, M (March 2021). "A progress report on reimplantation of the aortic valve". The Journal of Thoracic and Cardiovascular Surgery. 161 (3): 890–899.e1. doi:10.1016/j.jtcvs.2020.07.121. PMID 33008570. S2CID 222170984.
Sef, D; Bahrami, T; Raja, SG; Klokocovnik, T (June 2022). "Current trends in minimally invasive valve-sparing aortic root replacement-Best available evidence". Journal of Cardiac Surgery. 37 (6): 1684–1690. doi:10.1111/jocs.16453. PMID 35348237. S2CID 247777604.
Tooze, Adam; Abadi, Cam (March 6, 2024). "Adam's Upcoming Heart Surgery". YouTube. Foreign Policy. Retrieved December 30, 2024.
Yacoub, Magdi (1996). "Valve-Conserving Operation for Aortic Root Aneurysm or Dissection". Operative Techniques in Cardiac and Thoracic Surgery. 1 (1). Elsevier BV: 57–67. doi:10.1016/s1085-5637(07)70081-5. ISSN 1085-5637.
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"Dr. Tirone David: Looking back on a long, successful career". University Health Network Canada. 3 December 2010. Retrieved 27 Jun 2022.
David T, Feindel C (1992). "An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta". J Thorac Cardiovasc Surg. 103 (4): 617–21, discussion 622. doi:10.1016/S0022-5223(19)34942-6. PMID 1532219.
"Valve Sparing Aortic Root Replacement (David Procedure)". Columbia Surgery. November 9, 2023. Retrieved December 30, 2024.
Doty, Donald B; Arcidi, Joseph M (2000). "Methods for graft size selection in aortic valve-sparing operations". The Annals of Thoracic Surgery. 69 (2). Elsevier BV: 648–650. doi:10.1016/s0003-4975(99)01481-2. ISSN 0003-4975. PMID 10735728.
Mastrobuoni, Stefano; Govers, Pascal J.; Veen, Kevin M.; Jahanyar, Jama; Saane, Silke van; Segreto, Antonio; Zanella, Luca; Kerchove, Laurent de; Takkenberg, Johanna J. M.; Arabkhani, Bardia (2023). "Valve-sparing aortic root replacement using the reimplantation (David) technique: a systematic review and meta-analysis on survival and clinical outcome". Annals of Cardiothoracic Surgery. 12 (3): 149–158. doi:10.21037/acs-2023-avs1-0038. PMC 10248907. PMID 37304702.