Aortic Valve-Sparing Root Replacement (David I Procedure) in Adolescents: Long-Term Outcome

Introduction Aortic valve-sparing root replacement (David's procedure) is an especially appealing treatment option for young patients. Here, we present the short-, mid, and long-term outcomes of this operation in adolescent patients. Methods Between September 1994 and March 2014, 29 patients aged 6 to 21 years underwent the David-I procedure at our center. We conducted a retrospective study with follow-up. Results The mean age was 16.8 +/- 3.4 years and 90% ( n = 26) were male. Marfan's syndrome was present in 86% ( n = 25) of cases. Ninety-seven percent ( n = 28) of cases were performed electively, and one case (3%) was performed emergently for acute aortic dissection type A. There were no early perioperative deaths (0%). Follow-up, which was completed on 100% of patients, comprised a total of 394 patient years and a mean follow-up time of 13.6 +/- 5.4 years. The estimates for survival at 1, 5, and 10 years after initial surgery were 100, 97, and 93%, respectively. During follow-up, there were four (14%) late deaths and five (17%) aortic valve-related reoperations. The 1-, 5-, and 10-year estimates for freedom from valve-related reoperation were 100, 86, and 83%, respectively. The perioperative mortality for these five reoperations was 0%. Discussion Aortic valve-sparing root replacement can be performed in adolescents with a very low perioperative risk. Long-term survival seems to be affected by connective tissue diseases.

Automated summary

The retrospective study analyzed the outcomes of 29 adolescent patients aged 6 to 21 who underwent the David-I procedure, showing no early perioperative deaths but 14% late deaths and 17% aortic valve-related reoperations during long-term follow-up. Aortic valve-sparing root replacement in adolescents is associated with low perioperative risk.