Aortic Root Surgery with David Procedure. Initial Report

José Daniel Espinoza-Hernández; Rogelio Marroquín-Romero; Carlos Bernardo Villarreal-Rubio; Ulises Venegas-González; Marco Noguez-Rivera

2021, Number 2

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Cir Card Mex 2021; 6 (2)

Aortic Root Surgery with David Procedure. Initial Report

Espinoza-Hernández JD, Marroquín-Romero R, Villarreal-Rubio CB, Venegas-González U, Noguez-Rivera M

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Language: Spanish
References: 34
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ABSTRACT

The aortic valve preservation surgery with the David procedure is a technique that has proven to be as effective as the classic Bentall surgery for the surgical treatment of aortic root aneurysm. Although it has a higher reoperation rate, it offers the advantage of avoiding complications related to prosthetic valves and oral anticoagulation. We present our initial casuistry. Material. From September 2013 to May 2019, 14 patients with aortic root aneurysm, ascending aorta, or dissection underwent David procedure. There were 5 women and 9 men with a mean age of 42 years (from 17 to 62 years). Eight patients had Marfan syndrome. One patient presented Stanford B aortic dissection, nine had mild aortic insufficiency and the remaining 5 had a moderate degree, one patient had moderate to severe mitral regurgitation due to prolapse. The left ventricular ejection fraction was normal in 86% of the cases. The diameter of the aortic root was 56.7 mm (range, 48mm - 61.3 mm). Results. The David procedure was performed in all cases. The cause of aortic insufficiency in all cases was by alteration of its geometry due to the present dilation. One patient underwent concomitant mitral valve repair. We had a re-operation for bleeding. The average of days on mechanical ventilation were 1.6 and the in-hospital stay was 6.7 days. There were no other complications. At a 12-months follow-up, the freedom from moderate or severe (≥3+) aortic regurgitation was 100%. Only two patients remained with mild aortic valve regurgitation and all were asymptomatic and free from oral anticoagulation. Conclusions. The David procedure is a viable option with excellent results. It avoids complications related to anticoagulation and the presence of mechanical aortic valve prostheses. It is imperative to know the anatomy and physiology of the aortic root in order to achieve an adequate functional result. We must broaden the surgical horizon in young patients with aortic root aneurysm to give a better quality of life in the long term.

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