Department of Cardiothoracic Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Department of Cardiac Surgery, University of Bologna Hospital, Bologna, Italy.
Ann Thorac Surg. 2020 Feb;109(2):505-511. doi: 10.1016/j.athoracsur.2019.07.006. Epub 2019 Aug 3.
Since its introduction in 1992, multiple variations of the aortic valve-sparing David procedure technique have been described. Here, we present the short- and midterm outcomes of 2 centers using the straight tube graft (David-I) and the Valsalva prosthesis in patients who underwent isolated David procedure.
Between March 2002 and October 2015, 232 patients underwent the David procedure at 2 European centers. Patients received either a straight tube graft (David-I, group A, n = 103, 74% men) or Valsalva graft (group B, n = 129, 85% men). Mean age was 47 ± 17 years in group A and 48 ± 17 years in group B (P = .916).
There were significantly more cusp repairs in group B (n=28, 22%) compared with group A (n = 4, 4%, P < .001). The 30-day mortality rate was 1% (n = 1) in group A and 2% (n = 2, P = .698) in group B. Postoperative echocardiography showed aortic insufficiency ≥II in 0% (n = 0) of group A and 17% (n = 21) of group B (P < .001). Follow-up comprised 1530 patient-years, and survival was comparable between the 2 groups (P = .799). Follow-up echocardiography showed aortic insufficiency ≥II in 22% (n = 15) of group A and 39% (n = 33) of group B (P < .026). The rates for aortic valve-related reoperation were 8% (n = 8) in group A and 13% (n = 16) in group B (P = .241). Logistic Cox regression analysis identified bicuspid aortic valve (odds ratio, 3.435; 95% confidence interval, 1.459-8.083, P = .005) and postoperative aortic insufficiency ≥II (odds ratio, 5.988; 95% confidence interval, 2.545-14.088, P < .001) as risk factors for aortic valve-related reoperation.
The aortic valve-sparing David procedure has acceptable midterm results. Our results show that the David-I procedure with straight tube graft is not inferior to those performed with Valsalva prosthesis.
自 1992 年引入以来，已有多种改良的主动脉瓣环成形术技术被描述。在这里，我们报告了两个中心使用直管移植物（David-I）和瓦氏瓣进行单纯 David 手术的短期和中期结果。
2002 年 3 月至 2015 年 10 月，欧洲的 2 个中心共有 232 例患者接受 David 手术。患者接受直管移植物（David-I，A 组，n=103，74%为男性）或 Valsalva 移植物（B 组，n=129，85%为男性）。A 组平均年龄为 47±17 岁，B 组为 48±17 岁（P=0.916）。
B 组的瓣叶修复术（n=28，22%）明显多于 A 组（n=4，4%，P<0.001）。A 组的 30 天死亡率为 1%（n=1），B 组为 2%（n=2，P=0.698）。术后超声心动图显示 A 组主动脉瓣关闭不全≥II 级的为 0%（n=0），B 组为 17%（n=21，P<0.001）。随访时间为 1530 患者年，两组的生存率无差异（P=0.799）。随访超声心动图显示 A 组主动脉瓣关闭不全≥II 级的为 22%（n=15），B 组为 39%（n=33，P<0.026）。A 组主动脉瓣相关再手术率为 8%（n=8），B 组为 13%（n=16，P=0.241）。Logistic Cox 回归分析确定二叶式主动脉瓣（比值比，3.435；95%置信区间，1.459-8.083，P=0.005）和术后主动脉瓣关闭不全≥II 级（比值比，5.988；95%置信区间，2.545-14.088，P<0.001）是主动脉瓣相关再手术的危险因素。
保留主动脉瓣的 David 手术具有可接受的中期结果。我们的结果表明，使用直管移植物的 David-I 手术并不逊于使用瓦氏瓣的手术。
