The David Procedure for Salvage of a Failing Autograft After the Ross Operation

Valve-Sparing Reimplantation Technique for Treatment of Neoaortic Root Dilatation Late after the Arterial Switch Operation: Raising the Bar

“…Progressive neoaortic/pulmonary dilatation and concomitant valve regurgitation in the aortic position remains a major drawback following the ASO and in patients after the Ross operation. 6 7 Structural abnormality of the aortic wall, which have been proved histopathologically in patients with TGA, truncus arteriosus, and following the Ross operation might explain this phenomenon in addition to already described risk factors. 2 8 Based on the increasing number of adult patients with an ASO, the number of patients requiring reoperation for this indication will also increase.…”

“… 3 4 The valve-sparing reimplantation technique was first described by David and Feindel to treat patients with aortic regurgitation and ascending aortic aneurysm and has demonstrated excellent long-term outcomes in different valve pathologies. 5 6 These results inspired us to extend the indications for this operative technique. We report the use of the valve-sparing reimplantation technique in a patient with neoaortic root dilatation and concomitant neoaortic valve regurgitation arising late after the ASO.…”

Early and mid-term results of autograft rescue by Ross reversal: A one-valve disease need not become a two-valve disease

“…Preserving the autograft in the aortic position is the ideal solution for patients with moderate autograft dilatation, central regurgitation, symmetric cusps, and a wellfunctioning pulmonary allograft. 1,18,19,[21][22][23] A valvesparing operation to preserve the autograft in the aortic position is not always feasible in patients with valve degeneration, which is a common pathologic finding regardless of the technique used for the Ross procedure. 1,6,10,15,[23][24][25][26] Often, neither the autograft root nor the cusps are symmetrical, and tissue surrounding the autograft is asymmetrically distributed.…”

“…3,[21][22][23] In multiple series, however, many autografts have been discarded, and durability of aortic valve-sparing operations after the Ross procedure remains unknown. 1,3,22,23 Weimar and colleagues 3 reported 47 autograft-related reoperations in 44 patients, 22 (47%) performed as a valve-sparing procedure. Luciani and colleagues 23 reported 27 patients undergoing autograft-related reoperations, for root pathology in 17 and isolated valve pathology in 10.…”

“…Valve repair/ sparing was performed in 17 (63%), and on follow-up, 6 (35%) had required valve repair or replacement at 4.2 AE 2.9 years. Liebrich and colleagues 22 reported 49 autograft-related reoperations between 2005 and 2013, performing a David procedure in 18 of 35 patients (52%). In the European multicenter study of 87 valve-sparing reoperations for autograft failure, 1 patient had intraoperative failure and another 15 required autograft valve reoperation during follow-up, for a freedom from reintervention of 76% at 8 years, a greater failure rate than after a David procedure for any other indication.…”