Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2014 Dec;148(6):2883-7.
doi: 10.1016/j.jtcvs.2014.05.092. Epub 2014 Jul 19.

Comparison of David V valve-sparing root replacement and bioprosthetic valve conduit for aortic root aneurysm

Walter F DeNino  1 , John Matthew Toole  1 , Christopher Rowley  2 , Martha R Stroud  1 , John S Ikonomidis  3
Affiliations
Comparative Study

Comparison of David V valve-sparing root replacement and bioprosthetic valve conduit for aortic root aneurysm

Walter F DeNino et al. J Thorac Cardiovasc Surg. 2014 Dec.

Abstract

Objective: Valve sparing root replacement (VSRR) is an attractive option for the management of aortic root aneurysms with a normal native aortic valve. Therefore, we reviewed our experience with a modification of the David V VSRR and compared it with stented pericardial bioprosthetic valve conduit (BVC) root replacement in an age-matched cohort of older patients.

Methods: A total of 48 VSRRs were performed at our institution, excluding those on bicuspid aortic valves. We compared these cases with 15 aortic root replacements performed using a BVC during the same period. Subgroup analysis was performed comparing 16 VSRR cases and 15 age-matched BVC cases.

Results: The greatest disparity between the VSRR and BVC groups was age (53 vs 69 years, respectively; P < .0005). The matched patients were similar in terms of baseline demographics and differed only in concomitant coronary artery bypass grafting (2 VSRR vs 7 BVC patients; P = .036). None of the VSRR and 3 of the BVC procedures were performed for associated dissection (P = .101). Postoperative aortic insufficiency grade was significantly different between the 2 groups (P = .004). The cardiopulmonary bypass, crossclamp, and circulatory arrest times were not different between the VSRR and BVC groups (174 vs 187 minutes, P = .205; 128 vs 133 minutes, P = .376; and 10 vs 13 minutes, respectively; P = .175). No differences were found between the 2 groups with respect to postoperative complications. One postoperative death occurred in the BVC group and none in the VSRR group. The postoperative length of stay and aortic valve gradients were less in the VSRR group (6 vs 8 days, P = .038; 6 vs 11.4 mm Hg, P = .001). The intensive care unit length of stay was significantly less in the VSRR group (54 vs 110 hours, P = .001).

Conclusions: VSRR is an effective alternative to the BVC for aortic root aneurysm.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
New York Heart Association (NYHA) class preoperatively (Pre-op) and 1-year postoperatively (Post-op) in the valve sparing root replacement (VSRR) and bioprosthetic valve conduit (BVC) groups. The number of patients is indicated at the top of each bar. Two VSRR patients were lost to follow-up before 1 year postoperatively, and 1 BVC patient died intraoperatively.
FIGURE 2
FIGURE 2
Aortic valve gradients in valve sparing root replacement (VSRR) and bioprosthetic valved conduit (BVC) groups.
See this image and copyright information in PMC

References

    1. Wheat MW, Jr, Boruchow IB, Ramsey HW. Surgical treatment of aneurysms of the aortic root. Ann Thorac Surg. 1971;12:593–607. - PubMed
    1. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax. 1968;23:338–9. - PMC - PubMed
    1. David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg. 1992;103:617–21. - PubMed
    1. Sarsam MA, Yacoub M. Remodeling of the aortic valve annulus. J Thorac Cardiovasc Surg. 1993;105:435–8. - PubMed
    1. David TE. Aortic root aneurysms: remodeling or composite replacement? Ann Thorac Surg. 1997;64:1564–8. - PubMed

Publication types

MeSH terms