A modified David V: Technique and outcomes from a large single centre experience

Abstract

Introduction:

Replacement of the aortic root with a composite valve-graft and coronary reimplantation is the most widely performed operation for patients requiring aortic root replacement; however valve sparing operations have been developed to preserve the aortic valve in certain populations. Since they were first introduced, the remodeling and reimplantation techniques have undergone many refinements and modifications. We describe the technical steps and outcomes of a modified David V procedure, adapted from the Stanford modification, performed at our institution.

Methods:

Between November 2007 and March 2025, 417 patients underwent valve-sparing aortic root replacement at our institution. Of those, 185 patients underwent an adapted Stanford modification of valve-sparing aortic root replacement. A retrospective review of these patients was performed from a prospectively maintained institutional database.

Results:

Mean age was 47.6 ± 15.7 years and 81% were male. About 20.5% of patients had a heritable thoracic aortic disorder and 22.1% had a bicuspid aortic valve. The technique of our modified David V procedure is described. There was one post-operative mortality (0.5%) and no 30-day reinterventions. Early postoperative echocardiographic follow-up within 90 days was available in 91% of patients (n = 168), with no cases of greater than moderate aortic insufficiency. Survival at 1, 5, and 10 years was 99%, 98%, and 92%, respectively. Freedom from aortic valve or aortic re-operation at 1, 5, and 10 years was 99%, 97%,and 94%, respectively.

Conclusion:

While the specific type and size of graft used in valve-sparing aortic root replacement appears to matter less than meticulous technique and valve assessment, our series of 185 patients undergoing a modified David V procedure shows favorable early and midterm results.