Midterm follow-up of the reimplantation technique in patients with relatively normal annulus: is David I still a clinically valid option?

OBJECTIVE: The aim of this study was to evaluate the midterm results of the reimplantation technique with a straight tubular graft in patients with aortic root aneurysms with or without aortic insufficiency. METHODS: From February 2002 to November 2012, 51 consecutive patients underwent the David I valve-sparing aortic procedure for aortic root aneurysm; the mean age was 59.9±12.3 years. Nine patients (17.6%) had a bicuspid aortic valve. Patients were followed prospectively for 4.78±3.60 years (median, 5 years). Operative results, survival, freedom from redo aortic surgery and from recurrent aortic insufficiency greater than 2+ were assessed. RESULTS: No in-hospital mortality was recorded. In 5 cases, adjunctive procedures on the aortic valve were needed to achieve good leaflet coaptation. Aortic regurgitation was significantly lower at discharge (2.3±1.0 vs 0.3±0.5; P<.001). There were 5 postoperative deaths, all noncardiac related. Survival was 91.0%±4.4% at 5 years; freedom from redo aortic surgery was 96.8%±3.2% and freedom from recurrent aortic insufficiency greater than 2+ was 96.8%±3.2%. The outcomes in patients with repaired bicuspid aortic valves showed no significant differences compared to the outcomes in patients with repaired tricuspid valves. CONCLUSIONS: The reimplantation procedure using a straight tube is a safe and reproducible valve-sparing technique that can achieve no in-hospital mortality and durable midterm results, either in bicuspid or tricuspid valves. Further studies are needed to assess the behavior of repaired valves under physical stress at long-term follow-up.