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. 2014 Apr;18(4):432-7.
doi: 10.1093/icvts/ivt530. Epub 2014 Jan 6.

Long-term results of aortic valve resuspension in patients with aortic valve insufficiency and aortic root aneurysm

Nadejda Monsefi  1 , Andreas Zierer, Petar Risteski, Patrick Primbs, Aleksandra Miskovic, Afsaneh Karimian-Tabrizi, Sandra Folkmann, Anton Moritz
Affiliations

Long-term results of aortic valve resuspension in patients with aortic valve insufficiency and aortic root aneurysm

Nadejda Monsefi et al. Interact Cardiovasc Thorac Surg. 2014 Apr.

Abstract

Objectives: 'The David technique' may provide an alternative to conduit implantation in patients with an aneurysm of the ascending aorta and aortic valve insufficiency.

Methods: From 1991 to 2013, the David technique was performed in 249 consecutive patients in our department. The patient mean age was 58 ± 14 years; 71 (29%) were female and 178 (71%) male. A modification of the David technique was performed by creating a pseudosinus in 43 patients (17%) and by creating a neosinus in 123 patients (49%). The mean follow-up was 6 ± 4.5 years.

Results: There were six in-hospital (2.4%) and 30 late deaths (2.4%/patient-year). Cardiac-related events were the cause of death in three patients. The Kaplan-Meier estimate for 10 years survival was 77%. Four patients had perioperative neurological events, and only eight neurological events occurred during follow-up (0.6%/patient-year). Ten patients (0.8%/patient-year) required aortic valve replacement; one because of combined aortic valve stenosis and insufficiency and nine because of severe aortic valve insufficiency as a result of leaflet prolapse (n = 3), leaflet perforation (n = 1), abridgement of the right coronary leaflet (n = 1) and because of endocarditis (n = 4). Three cases of bleeding were observed (0.24%/patient-year). Freedom from reoperation or aortic valve insufficiency ≥2° was 80% at 10 years.

Conclusions: Aortic valve sparing to treat patients with an ascending aortic aneurysm with aortic valve insufficiency is a durable procedure. Aortic valve function remains stable for many years. Valve-related complications are rare, and the rate of reoperations is not increased in comparison to conduit root replacement.

Keywords: Aortic root; Aortic valve repair.

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Figures

Figure 1:
Figure 1:
Kaplan–Meier curve for survival.
Figure 2:
Figure 2:
Kaplan–Meier curve for freedom from reoperation.
Figure 3:
Figure 3:
Kaplan–Meier curve for freedom from reoperation or aortic valve insufficiency (AI) ≥ 2°.
See this image and copyright information in PMC

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