The outcome after aortic valve-sparing (David) operation in 179 patients: A single-centre experience

Sergey Leontyev, Constanze Trommer, Sreekumar - Subramanian, Sven Lehmann, Yaroslava Dmitrieva, Martin Misfeld, Friedrich W. Mohr, Michael A. Borger

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Objectives: The David aortic valve-sparing reimplantation (AVr-D) operation is increasingly being used in patients with aortic root aneurysmal disease and pliable aortic cusps. The objective of this study was to assess our early and medium-term outcomes with the AVr-D operation. Methods: Between 2003 and 2011, a total of 179 patients underwent AVr-D procedures. The mean patient age was 49.7 ± 15.1 years, and 23.5% (n = 42) were females. Marfan syndrome was present in 17.3% of patients (n = 31), and acute Type A aortic dissection in 15.6% (n = 28). Clinical follow-up was 100% complete and was 1.8 ± 1.6 years (0 days to 7.5 years) long. Echocardiographic follow-up was performed 2.2 ± 1.5 years (0 days to 7.5 years) postoperatively and was 77% complete. Results: Early mortality was 1.1% (n = 2), with both deaths occurring in patients with Type A dissection. Pre-discharge echocardiography revealed no patients with >2+ aortic insufficiency (AI), 19.6% of patients (n = 34) with 1+ or 2+ AI and 80.4% of patients (n = 145) with trace or no AI. Left ventricular end-diastolic diameters decreased significantly from 5.6 ± 0.9 to 5.1 ± 0.8 cm early postoperatively (P < 0.01). Transvalvular maximum gradients were similar before discharge and at last follow-up (10.6 ± 5.4 vs. 10.0 ± 8.2 mmHg, P = 0.4). AI grade increased significantly over time (0.3 ± 0.4 before discharge vs. 0.5 ± 0.6 at follow-up, P = 0.01), but remained less than moderate in 93.6% of patients. Four patients required aortic valve re-replacement during follow-up, two due to early endocarditis and two due to non-coronary leaflet prolapse in Marfan patients. Five-year freedom from aortic valve reoperation was 95.9 ± 2.0%. Conclusions: AVr-D is associated with a low mortality and morbidity rate, even in patients with Type A aortic dissection. Although a slightly higher rate of recurrent AI may be present in patients with Marfan syndrome, freedom from recurrent AI and reoperation remains excellent during medium-term follow-up. The David operation should be considered the gold standard for patients with proximal aortic root pathology (aneurysm or dissection) and pliable aortic cusps.

Original languageEnglish (US)
Article numberezs011
Pages (from-to)261-267
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume42
Issue number2
DOIs
StatePublished - Aug 2012
Externally publishedYes

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Aortic Valve
Dissection
Marfan Syndrome
Reoperation
Aortic Diseases
Mortality
Replantation
Prolapse
Endocarditis
Aneurysm
Echocardiography

Keywords

  • Aortic valve-sparing operation
  • Outcome
  • Reimplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

The outcome after aortic valve-sparing (David) operation in 179 patients : A single-centre experience. / Leontyev, Sergey; Trommer, Constanze; Subramanian, Sreekumar -; Lehmann, Sven; Dmitrieva, Yaroslava; Misfeld, Martin; Mohr, Friedrich W.; Borger, Michael A.

In: European Journal of Cardio-thoracic Surgery, Vol. 42, No. 2, ezs011, 08.2012, p. 261-267.

Research output: Contribution to journalArticle

Leontyev, S, Trommer, C, Subramanian, S, Lehmann, S, Dmitrieva, Y, Misfeld, M, Mohr, FW & Borger, MA 2012, 'The outcome after aortic valve-sparing (David) operation in 179 patients: A single-centre experience', European Journal of Cardio-thoracic Surgery, vol. 42, no. 2, ezs011, pp. 261-267. https://doi.org/10.1093/ejcts/ezs011
Leontyev, Sergey ; Trommer, Constanze ; Subramanian, Sreekumar - ; Lehmann, Sven ; Dmitrieva, Yaroslava ; Misfeld, Martin ; Mohr, Friedrich W. ; Borger, Michael A. / The outcome after aortic valve-sparing (David) operation in 179 patients : A single-centre experience. In: European Journal of Cardio-thoracic Surgery. 2012 ; Vol. 42, No. 2. pp. 261-267.
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abstract = "Objectives: The David aortic valve-sparing reimplantation (AVr-D) operation is increasingly being used in patients with aortic root aneurysmal disease and pliable aortic cusps. The objective of this study was to assess our early and medium-term outcomes with the AVr-D operation. Methods: Between 2003 and 2011, a total of 179 patients underwent AVr-D procedures. The mean patient age was 49.7 ± 15.1 years, and 23.5{\%} (n = 42) were females. Marfan syndrome was present in 17.3{\%} of patients (n = 31), and acute Type A aortic dissection in 15.6{\%} (n = 28). Clinical follow-up was 100{\%} complete and was 1.8 ± 1.6 years (0 days to 7.5 years) long. Echocardiographic follow-up was performed 2.2 ± 1.5 years (0 days to 7.5 years) postoperatively and was 77{\%} complete. Results: Early mortality was 1.1{\%} (n = 2), with both deaths occurring in patients with Type A dissection. Pre-discharge echocardiography revealed no patients with >2+ aortic insufficiency (AI), 19.6{\%} of patients (n = 34) with 1+ or 2+ AI and 80.4{\%} of patients (n = 145) with trace or no AI. Left ventricular end-diastolic diameters decreased significantly from 5.6 ± 0.9 to 5.1 ± 0.8 cm early postoperatively (P < 0.01). Transvalvular maximum gradients were similar before discharge and at last follow-up (10.6 ± 5.4 vs. 10.0 ± 8.2 mmHg, P = 0.4). AI grade increased significantly over time (0.3 ± 0.4 before discharge vs. 0.5 ± 0.6 at follow-up, P = 0.01), but remained less than moderate in 93.6{\%} of patients. Four patients required aortic valve re-replacement during follow-up, two due to early endocarditis and two due to non-coronary leaflet prolapse in Marfan patients. Five-year freedom from aortic valve reoperation was 95.9 ± 2.0{\%}. Conclusions: AVr-D is associated with a low mortality and morbidity rate, even in patients with Type A aortic dissection. Although a slightly higher rate of recurrent AI may be present in patients with Marfan syndrome, freedom from recurrent AI and reoperation remains excellent during medium-term follow-up. The David operation should be considered the gold standard for patients with proximal aortic root pathology (aneurysm or dissection) and pliable aortic cusps.",
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AU - Leontyev, Sergey

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AU - Subramanian, Sreekumar -

AU - Lehmann, Sven

AU - Dmitrieva, Yaroslava

AU - Misfeld, Martin

AU - Mohr, Friedrich W.

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N2 - Objectives: The David aortic valve-sparing reimplantation (AVr-D) operation is increasingly being used in patients with aortic root aneurysmal disease and pliable aortic cusps. The objective of this study was to assess our early and medium-term outcomes with the AVr-D operation. Methods: Between 2003 and 2011, a total of 179 patients underwent AVr-D procedures. The mean patient age was 49.7 ± 15.1 years, and 23.5% (n = 42) were females. Marfan syndrome was present in 17.3% of patients (n = 31), and acute Type A aortic dissection in 15.6% (n = 28). Clinical follow-up was 100% complete and was 1.8 ± 1.6 years (0 days to 7.5 years) long. Echocardiographic follow-up was performed 2.2 ± 1.5 years (0 days to 7.5 years) postoperatively and was 77% complete. Results: Early mortality was 1.1% (n = 2), with both deaths occurring in patients with Type A dissection. Pre-discharge echocardiography revealed no patients with >2+ aortic insufficiency (AI), 19.6% of patients (n = 34) with 1+ or 2+ AI and 80.4% of patients (n = 145) with trace or no AI. Left ventricular end-diastolic diameters decreased significantly from 5.6 ± 0.9 to 5.1 ± 0.8 cm early postoperatively (P < 0.01). Transvalvular maximum gradients were similar before discharge and at last follow-up (10.6 ± 5.4 vs. 10.0 ± 8.2 mmHg, P = 0.4). AI grade increased significantly over time (0.3 ± 0.4 before discharge vs. 0.5 ± 0.6 at follow-up, P = 0.01), but remained less than moderate in 93.6% of patients. Four patients required aortic valve re-replacement during follow-up, two due to early endocarditis and two due to non-coronary leaflet prolapse in Marfan patients. Five-year freedom from aortic valve reoperation was 95.9 ± 2.0%. Conclusions: AVr-D is associated with a low mortality and morbidity rate, even in patients with Type A aortic dissection. Although a slightly higher rate of recurrent AI may be present in patients with Marfan syndrome, freedom from recurrent AI and reoperation remains excellent during medium-term follow-up. The David operation should be considered the gold standard for patients with proximal aortic root pathology (aneurysm or dissection) and pliable aortic cusps.

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KW - Outcome

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