Aortic valve-sparing operation according to DAVID using a prosthesis to remodel the aortic sinuses-a video presentation

Objective: Valve sparing operations in patients with aortic root aneurysm appear to be the treatment of choice as the hemodynamic result is excellent and no anticoagulation is necessary. However, sewing the aortic valve ring to the end of the prosthesis the valve ring's scalloped profile is forced into one level, this may lead to cusp degeneration in the longterm run.

Methods: 25 patients, mean age 61.2±11.9 years, 18 male, with ascending aortic aneurysm and additional aortic valve regurgitation were treated with a David procedure. We describe a technique for valve sparing operation with an aortic root Dacron-prosthesis (Gelweave Valsalva, Sulzer, Vascutek, Renfrewshire, Scotland) that allows an anatomical reconstruction of the sinuses. Laying the prosthesis'lower suture line to meet the threefold scalloped profile of the valve ring secured to maintain its architecture.

Results: Operations were performed without complications. In 8 patients a hemi arch was carried out using circulatory arrest and retrograde cerebral perfusion. In 4 patients an additional bypass-operation was performed. In all patients postoperative echocardiography revealed only trivial or no regurgitation. MRI demonstrated anatomical reconstruction of the sinuses of valsalva suggesting room for contact free cusp movement. After a mean follow-up of 27.6±12.2 months aortic valve function is fine in all patients.

Conclusions: A new sewing technique for implantation of the valsalva prosthesis durig valve sparing operation according to David was used safely and effectively in patients with aortic root aneurysm, allowing a better anatomical reconstruction of the sinuses of valsalva.