Valve-sparing David procedure via minimally invasive access does not compromise outcome

Shrestha, Malakh; Kaufeld, Tim; Shrestha, Pamila; Martens, Andreas; Rustum, Saad; Rudolph, Linda; Krüger, Heike; Arar, Morsi; Haverich, Axel; Beckmann, Erik

doi:10.3389/fcvm.2022.966126

Cited by 10 publications

(11 citation statements)

References 12 publications

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“… Schematic representation and summary of the currently available access techniques. Yellow dotted lines represent the respective incisions [ 6 , 7 , 9 , 10 , 11 , 13 , 14 , 17 ]. …”

Section: Figurementioning

confidence: 99%

“…Over the last decade, the minimally invasive access has more and more become the standard approach for coronary revascularization and mitral valve surgery as well as for aortic valve and aortic root replacement [ 2 , 3 , 4 , 5 ]. Here, Shrestha et al reported comparable peri- and postoperative outcomes in 42 patients undergoing David procedure through an upper hemisternotomy compared to 178 patients operated through full sternotomy, while operation and cross clamp times were slightly longer [ 6 ]. As the next logical step, minimally invasive approaches for more complex operations including the supracommissural ascending aorta have currently moved into the center of attention.…”

Section: Introductionmentioning

confidence: 99%

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Expanding the Minimally Invasive Approach towards the Ascending Aorta—A Practical Overview of the Currently Available Techniques

Helms,

Schmack,

Weymann

et al. 2023

Medicina

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Minimally invasive techniques have gained immense importance in cardiovascular surgery. While minimal access strategies for coronary and mitral valve surgery are already widely accepted and often used as standard approaches, the application of minimally invasive techniques is currently expanded towards more complex operations of the ascending aorta as well. In this new and developing field, various techniques have been established and reported ranging from upper hemisternotomy approaches, which allow even extensive operations of the ascending aorta to be performed through a minimally invasive access to sternal sparing thoracotomy strategies, which completely avoid sternal trauma during ascending aorta replacements. All of these techniques place high demands on patient selection, preoperative planning, and practical surgical implementation. Application of these strategies is currently limited to high-volume centers and highly experienced surgeons. This narrative review gives an overview of the currently available techniques with a special focus on the practical execution as well as the advantages and disadvantages of the currently available techniques. The first results demonstrate the practicability and safety of minimally invasive techniques for replacement of the ascending aorta in a well-selected patient population. With success and complication rates comparable to classic full sternotomy, the proof of concept for minimally invasive replacement of the ascending aorta is now achieved.

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“… Schematic representation and summary of the currently available access techniques. Yellow dotted lines represent the respective incisions [ 6 , 7 , 9 , 10 , 11 , 13 , 14 , 17 ]. …”

Section: Figurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Expanding the Minimally Invasive Approach towards the Ascending Aorta—A Practical Overview of the Currently Available Techniques

Helms,

Schmack,

Weymann

et al. 2023

Medicina

Self Cite

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“…Additional procedures were performed whenever indicated and included coronary bypasssurgery, additional valve-surgery or (partial) replacement of the aortic arch. Despite technically possible through minimally invasive access (7), for the sake of optimal exposure and considering the potential need for concomitant procedures, all David operations in this study were performed through a full sternotomy.…”

Section: Operative Techniquementioning

confidence: 99%

Twenty-five year experience with aortic valve-sparing root replacement in a single teaching center

Sromicki

Hemelrijck

Schmiady

et al. 2023

Front. Cardiovasc. Med.

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ObjectivesAortic valve-sparing root replacement (AVSRR) is a technically demanding procedure. In experienced centers it offers excellent short- and long-term results, making the procedure an attractive alternative for aortic root replacement especially in young patients. The aim of this study was to analyze long-term results of AVSRR using the David operation in our institution over the last 25 years.MethodsThis is a single-center retrospective analysis of outcomes of David operations performed in a teaching institution not running a large AVSRR-program. Pre-, intra- and postoperative data were collected from the institutional electronic medical record system. Follow-up data were collected through direct contact of the patients and their cardiologists/primary care physicians.ResultsBetween 02/1996 and 11/2019, 131 patients underwent David operation in our institution by a total of 17 different surgeons. Median age was 48 (33–59), 18% were female. Elective surgery was performed in 89% of the cases, 11% were operated as emergency in the setting of an acute aortic dissection. Connective tissue disease was present in 24% and 26% had a bicuspid aortic valve. At hospital admission 61% had aortic regurgitation grade ≥3, 12% were in functional NYHA-class ≥III. 30-day mortality was 2%, 97% of the patients were discharged with aortic regurgitation ≤2. In 10-year follow-up, 15 (12%) patients had to be re-operated because of root-related complications. Seven patients (47%) received a transcatheter aortic valve implantation, 8 (53%) required surgical replacement of the aortic valve or a Bentall-De Bono operation. Estimated reoperation-free survival at 5 and 10 years was 93.5% ± 2.4% and 87.0% ± 3.5%, respectively. Subgroup analysis showed no differences in reoperation-free survival for patients presenting with a bicuspid valve or preoperative aortic regurgitation ≥3. However a preoperative left ventricular end diastolic diameter of ≥5.5 cm was associated with worse outcome.ConclusionDavid operations can be performed with excellent perioperative and 10-year follow-up outcomes in centers not running large AVSRR-programs.

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“…Therefore, minimally invasive David procedure via an upper ministernotomy is an excellent example of MICS. Nevertheless, AV repair and VSARR are complex and demanding procedures and therefore still not routinely performed in MICS, yet technically feasible and safe ( 5 ).…”

Section: Commentmentioning

confidence: 99%

David procedure through an upper ministernotomy

Holubec¹,

Al‐Obaidi²,

Walther³

et al. 2023

Ann Cardiothorac Surg

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An asymptomatic 58-year-old patient was referred to our department for aortic root aneurysm of 51 mm with progression of 2 mm in one year. Preoperative evaluation using a computed tomography (CT) scan confirmed the aortic root aneurysm and ruled out any coronary artery disease. A transthoracic echocardiography showed a tricuspid aortic valve (AV) with moderate regurgitation. Valve-sparing aortic root replacement (VSARR) with AV reimplantation (David procedure) (1) was therefore scheduled. In standard cases, we perform the David procedure in minimally invasive [minimally invasive cardiac surgery (MICS)] fashion via upper ministernotomy into the third right intercostal space (ICS) with percutaneous cannulation of the right femoral vein. Surgical techniques PreparationAfter induction of general anesthesia and standard anesthesiologic preparation, the patient is placed in supine position, prepped and draped with both groins exposed.

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Valve-sparing David procedure via minimally invasive access does not compromise outcome

Cited by 10 publications

References 12 publications

Expanding the Minimally Invasive Approach towards the Ascending Aorta—A Practical Overview of the Currently Available Techniques

Expanding the Minimally Invasive Approach towards the Ascending Aorta—A Practical Overview of the Currently Available Techniques

Twenty-five year experience with aortic valve-sparing root replacement in a single teaching center

David procedure through an upper ministernotomy

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