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

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.966126

DOI=10.3389/fcvm.2022.966126

ISSN=2297-055X

ABSTRACT=<sec><title>Objectives</title><p>Aortic valve sparing-aortic root replacement (David procedure) has not been routinely performed <italic>via</italic> minimally invasive access due to its complexity. We compared our results of elective David procedure <italic>via</italic> minimally invasive access to those <italic>via</italic> a full sternotomy.</p></sec><sec><title>Methods</title><p>Between 1993 and 2019, a total of 732 patients underwent a valve sparing root replacement (David) procedure. Out of these, 220 patients underwent elective David-I procedure (isolated) without any other concomitant procedures at our center. Patients were assigned to either group A (<italic>n</italic> = 42, mini-access) or group B (<italic>n</italic> = 178, full sternotomy).</p></sec><sec><title>Results</title><p>Cardiopulmonary bypass time were 188.5 ± 35.4 min in group A and 149.0 (135.5–167.5) in group B (<italic>p</italic> &lt; 0.001). Aortic cross-clamp time were 126.2 ± 27.2 min in group A and 110.0 (97.0–126.0) in group B (<italic>p</italic> &lt; 0.001). Post-operative echocardiography showed aortic insufficiency ≤ I° in 41 (100%) patients of group A and 155 (95%) of group B. In-hospital mortality was 2.4% (<italic>n</italic> = 1) in group A and 0% (<italic>n</italic> = 0) in group B (<italic>p</italic> = 0.191). Perioperative stroke occurred in 1 (2.4%) patient of group A and 2 (1.1%) patients of group B (<italic>p</italic> = 0.483). Reexploration for bleeding was necessary in 4 (9.5%) patients of group A and 7 (3.9%) of group B (<italic>p</italic> = 0.232). Follow-up was complete for 98% of all patients. The 1-, 2-, 4-, and 6-year survival rates were: 97, 97, 97, and 97%, in group A (mini-access) and 99, 96, 95, and 92% in group B (full sternotomy), respectively. The rates for freedom from valve-related re-operation at 1, 2, 4, and 6 years after initial surgery were: 97, 95, 95, and 84% in group A and 97, 95, 91, and 90% in group B, respectively.</p></sec><sec><title>Conclusion</title><p>Early post-operative results after David procedure <italic>via</italic> minimally invasive access are comparable to conventional full sternotomy. Meticulous attention to hemostasis is a critical factor during minimally access David procedures. Long-term outcome including the durability of the reimplanted aortic valve seems to be comparable, too.</p></sec>