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David aortic valve-sparing reimplantation versus biological aortic root replacement: a retrospective analysis of 411 patients

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objectives

This study aimed to compare short- and long-term results for patients undergoing either aortic valve-sparing reimplantation (David) procedure (AVr-D) or biological aortic root replacement (Bentall) procedure (ARr-B-bio) for aortic root pathology.

Methods

We compared outcomes for patients who underwent AVr-D (n = 261) or ARr-B-bio (n = 150) between 2000 and 2015 at our institution. The mean age of patients was 55 ± 13 years and 21.7% (n = 89) were female. ARr-B-bio patients were significantly older than AVr-D patients (58 ± 10 vs 53 ± 15 years, p < 0.001) and had a significantly lower incidence of connective tissue disorders (2.0% vs 16.9%, p < 0.001). Follow-up was complete in 88% of patients.

Results

Mortality at 30 days was 1.2% (n = 5) overall, at 0.4% (n = 1) significantly lower in the AVr-D group compared with 2.7% (n = 4) in the ARr-B-bio group (p = 0.04). Postoperative low cardiac output was more common in ARr-B-bio patients (n = 4) versus AVr-D patients (n = 0; p = 0.008). The occurrence of postoperative strokes was 2.2% (n = 9) in both groups, without significant differences (p = 0.84). Five- and ten-year survival was 93.7 ± 1.8% and 84.4 ± 4.7% in patients who received AVr-D and 90.9 ± 2.6% and 84.6 ± 5.4% for ARr-B-bio patients (log-rank p = 0.37). Using Cox regression analysis, age (HR 1.06; 95% CI 1.02–1.10, p = 0.002), smoking (HR 2.74; 95% CI 1.28–5.86, p = 0.01), and emergency surgery (HR 6.58; 95% CI 1.69–25.54, p = 0.007) were found to be independent predictors of long-term mortality.

There was no difference in freedom from reoperation between AVr-D (89.4 ± 3.4% at 10 years) and ARr-B-bio (80.4 ± 7.5% at 10 years, log-rank p = 0.66) patients, nor for freedom from stroke, bleeding, myocardial infarction, or endocarditis during follow-up.

Conclusions

Short-term outcomes for both AVr-D and ARr-B-bio are excellent in patients with aortic root pathology. The long-term outcomes were associated with comparable survival and freedom from reoperation. AVr-D may be preferable to ARr-B-bio in patients with suitable pathoanatomy.

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Author notes

  1. Lukas Schamberger and Sergey Leontyev contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiac Surgery, Leipzig Heart Centre, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany

    Lukas Schamberger, Sergey Leontyev, Piroze Minoo Davierwala, Konstantin Von Aspern, Sven Lehmann, Martin Misfeld & Michael Andrew Borger

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  1. Lukas Schamberger
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  2. Sergey Leontyev
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  3. Piroze Minoo Davierwala
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  4. Konstantin Von Aspern
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  5. Sven Lehmann
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  6. Martin Misfeld
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  7. Michael Andrew Borger
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Corresponding author

Correspondence to Sergey Leontyev.

Ethics declarations

The local ethics committee approved the study and waived individual patient consent for retrospective review. This article does not contain any studies with animals performed by any of the authors.

Conflict of interest

Lukas Schamberger declares that he has no conflict of interest.

Sergey Leontyev receives proctoring honoraria fees from Medtronic, Abott (St. Jude Medical).

Piroze M. Davierwala declares that he has no conflict of interest.

Konstantin Von Aspern declares that he has no conflict of interest.

Sven Lehmann receives honoraria fees from Abott (St. Jude Medical).

Martin Misfeld declares that he has no conflict of interest.

Michael Borger receives speakers’ honoraria/consulting fees from Edwards Lifesciences, Medtronic, Abott (St. Jude Medical), and CryoLife.

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Schamberger, L., Leontyev, S., Davierwala, P.M. et al. David aortic valve-sparing reimplantation versus biological aortic root replacement: a retrospective analysis of 411 patients. Indian J Thorac Cardiovasc Surg 36 (Suppl 1), 97–103 (2020). https://doi.org/10.1007/s12055-019-00873-4

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  • DOI: https://doi.org/10.1007/s12055-019-00873-4

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