Our Summary
This study looks at a specific type of heart surgery known as aortic valve-sparing root reimplantation (AVSRR), also known as the David procedure. This operation has been done at the researchers’ hospital for over 25 years, with more than 700 surgeries performed.
The study looked at 732 patients who had this surgery between 1993 and 2019. Most of the patients were men, and they were on average 53 years old. Some of them had Marfan syndrome or bicuspid aortic valve, which are conditions that can affect the heart. The main reason for surgery was an aortic root aneurysm, a bulge in the blood vessel that can lead to a lethal rupture if not treated.
Most patients had a straightforward procedure with a tube graft, and some also had other cardiac procedures at the same time. The surgery was relatively safe, with a low rate of deaths in the hospital.
After the surgery, they followed up with the patients for about 10 years on average. Most patients had no or very little aortic insufficiency, which means their aortic valve was working well. The survival rates were 93% after 1 year, 88% after 5 years, 77% after 10 years, and 65% after 15 years. The rates of not needing another valve-related operation were also high.
The study identified age, high cholesterol levels, preoperative level of left ventricular ejection function (how well the heart pumps blood), and postoperative degree of aortic insufficiency as risk factors for future problems or the need for another operation.
In conclusion, the David procedure is a very safe operation with a low risk of complications and good long-term outcomes for most patients.
FAQs
- What is aortic valve-sparing root reimplantation (AVSRR) or the David procedure?
- What are the survival rates after undergoing the David procedure?
- What were identified as risk factors for future problems or the need for another operation after the David procedure?
Doctor’s Tip
A helpful tip a doctor might give a patient about aortic valve replacement is to make sure to follow up with regular check-ups and screenings to monitor the health of the heart and the function of the replaced valve. It is also important to maintain a healthy lifestyle, including regular exercise, a balanced diet, and managing any underlying health conditions such as high cholesterol. By taking proactive steps to care for your heart, you can help ensure the long-term success of the valve replacement surgery.
Suitable For
Patients who are typically recommended for aortic valve replacement, specifically the David procedure, include those with aortic root aneurysm, Marfan syndrome, bicuspid aortic valve, or other conditions affecting the heart. These patients may be at risk for a lethal rupture of the blood vessel if the aneurysm is not treated. Additionally, patients with high cholesterol levels, poor left ventricular ejection function, or significant aortic insufficiency may also be recommended for this surgery. Overall, the David procedure has been shown to have low rates of complications and good long-term outcomes for most patients.
Timeline
Overall, a patient who undergoes aortic valve replacement will typically experience symptoms such as shortness of breath, chest pain, fatigue, and dizziness leading up to the surgery. They will undergo preoperative testing and evaluation to determine the best course of treatment.
After the surgery, patients will spend time recovering in the hospital, usually for a few days to a week, before being discharged. They will need to follow a strict postoperative care plan, including medication management, physical therapy, and follow-up appointments with their healthcare team.
In the long term, patients can expect to see an improvement in their symptoms and overall quality of life. With proper care and monitoring, most patients can expect to have good long-term outcomes and a reduced risk of future complications.
What to Ask Your Doctor
- What is the specific reason for recommending aortic valve replacement in my case?
- What are the potential risks and complications associated with the David procedure?
- How experienced are you and your team in performing aortic valve-sparing root reimplantation?
- What is the expected recovery time and rehabilitation process after the surgery?
- Will I need to take any medications or make lifestyle changes after the surgery?
- How often will I need follow-up appointments to monitor my progress?
- What are the signs or symptoms that I should watch out for after the surgery that may indicate a complication?
- Are there any restrictions or limitations on activities that I should be aware of post-surgery?
- What is the long-term prognosis for someone who undergoes the David procedure?
- Are there any specific risk factors in my case that may affect the success of the surgery or my long-term outcomes?
Reference
Authors: Beckmann E, Martens A, Krüger H, Korte W, Kaufeld T, Stettinger A, Haverich A, Shrestha ML. Journal: Eur J Cardiothorac Surg. 2021 Sep 11;60(3):642-648. doi: 10.1093/ejcts/ezab136. PMID: 33778863