22-Year Experience With Valve-Sparing Aortic Root Replacement in a Latin American Center

Abstract

Objective

Describe the short- and long-term outcomes of valve-sparing aortic root replacement for aortic root aneurysm repair in a lower-volume center

Methods

We included patients with aortic root aneurysm who underwent the David procedure from January 2002 to June 2024 at our institution, identified by the institutional cardiac surgery database that follows the coding guidelines of the STS. We collected data from pre-, intra-, and postoperative periods. Follow-up was performed through the outpatient clinic, government databases, and telephone interviews. The main outcomes were survival, valve regurgitation recurrence, and freedom from reoperation.

Results

150 patients were identified in 22 years. The mean age was 52 years, 81% were male, and the most frequent comorbidity was hypertension. 23 patients had Marfan syndrome and a bicuspid aortic valve. 47% of patients had severe AR, and 15% had moderate AR. 65% patients underwent elective surgery. There was concomitant aortic arch repair in 6 patients, mitral valve repair in 10 patients, and one patient required descending aorta repair. There was one perioperative death. Freedom from significant AR was 92% at 9 years, and freedom from reoperation was 90% at 8 years. There were 8 valve-related reoperations and 11 deaths in the follow-up period. Survival was 97% after 10 years.

Conclusions

Valve-sparing aortic root replacement is a safe procedure that provides outstanding short- and long-term outcomes. In the long term, AR improvement is remarkable and maintainable. In our background, the David procedure has shown favorable outcomes comparable to those reported in high-volume income centers.