Department of Thoracic- and Cardiovascular Surgery of Goethe University Hospital, Frankfurt a.M., Germany.
Department of Thoracic- and Cardiovascular Surgery of Goethe University Hospital, Frankfurt a.M., Germany.
Int J Surg. 2015 Oct;22:99-104. doi: 10.1016/j.ijsu.2015.08.031. Epub 2015 Aug 24.
The David Procedure may provide an attractive alternative to aortic root replacement in patients with aortic valve insufficiency (AI) even in the emergency setting of an acute type A aortic dissection (AAD).
From 1996 to 2011 the David Procedure was performed in 23 patients with AAD in our department. Patients' mean age was 49 ± 15 years and 70% (n = 16) were male. Concomitant hemiarch replacement was performed in 19 patients while the remaining 4 patients underwent full arch replacement. Additional leaflet prolapse was corrected by plication in 5 cases. A modification of the classic David technique was performed by creating a pseudosinus in 6 patients (26%) and a neosinus in 9 patients (39%). Mean follow up was 7.7 ± 3 years.
Thirty-day mortality was zero. There were 4 late deaths (17%). One patient suffered a perioperative neurologic event (4%). One further patient suffered a late stroke during follow up (0.6%/pt-yr). Three patients (1.7%/pt-yr) required aortic valve reoperation during follow up: in 2 cases leaflet perforation was observed, and one patient had to undergo valve replacement because of endocarditis with severe AI. There were two cases of bleeding events (1.1%/pt-yr) at follow up. The linearized rate for recurrent AI ≥ 2° was 1.1%/pt-yr.
The David Procedure certainly provides a challenging option to treat selected young patients with AI in the presence of AAD. However, current data suggest that it is safe and feasible.
Long-term valve-related events of the David Procedure applied in emergency cases are rare and aortic valve function remains stable for many years.
即使在急性 A 型主动脉夹层 (AAD) 的紧急情况下，David 手术也可能为患有主动脉瓣关闭不全 (AI) 的患者提供一种有吸引力的主动脉根部置换替代方法。
1996 年至 2011 年，我们科室对 23 例 AAD 患者进行了 David 手术。患者平均年龄为 49 ± 15 岁，70%（n = 16）为男性。19 例患者同时行半弓置换，其余 4 例患者行全弓置换。5 例患者通过折叠术纠正了额外的瓣叶脱垂。6 例患者（26%）采用改良 David 技术，在主动脉窦内创建一个假窦，9 例患者（39%）创建一个新窦。平均随访 7.7 ± 3 年。
30 天死亡率为 0。有 4 例晚期死亡（17%）。1 例患者发生围手术期神经系统事件（4%）。1 例患者在随访期间发生晚期卒中（0.6%/pt-yr）。3 例患者（1.7%/pt-yr）在随访期间需要再次行主动脉瓣手术：2 例患者观察到瓣叶穿孔，1 例患者因严重 AI 并发感染性心内膜炎需要行瓣膜置换。随访期间有 2 例出血事件（1.1%/pt-yr）。复发性 AI ≥ 2°的线性化率为 1.1%/pt-yr。
David 手术为治疗伴有 AAD 的 AI 年轻患者提供了一种极具挑战性的选择。然而，目前的数据表明该手术是安全可行的。
David 手术应用于急症患者的长期瓣膜相关事件罕见，主动脉瓣功能多年保持稳定。
