David Procedure: A 21-year Experience With 300 Patients.

Autor:	Manganiello S; Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France., Soquet J; Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France., Mugnier A; Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France., Rousse N; Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France; Module for Education and Research Collaboration in Statistics, University of Lille, GIVRE-MERCS, Lille, France., Juthier F; Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France., Banfi C; Faculty of Medicine, Geneva Haemodynamic Research Group, University of Geneva, Geneva, Switzerland; Department of Cardiothoracic Surgery, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato Milan, University of Milan, Milan, Italy., Loobuyck V; Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France., Coisne A; Department of Clinical Physiology and Echocardiography, University of Lille, CHU Lille, Lille, France., Richardson M; Department of Clinical Physiology and Echocardiography, University of Lille, CHU Lille, Lille, France., Marechaux S; Department of Cardiology and Echocardiography, Groupement des hôpitaux de l'Institut catholique lillois, Lille, France., Moussa MD; Department of Cardiovascular Anesthesia and Intensive Care, University of Lille, CHU Lille, Lille, France., Robin E; Department of Cardiovascular Anesthesia and Intensive Care, University of Lille, CHU Lille, Lille, France., Pinçon C; Module for Education and Research Collaboration in Statistics, University of Lille, GIVRE-MERCS, Lille, France., Prat A; Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France., Vincentelli A; Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France. Electronic address: andre.vincentelli@chu-lille.fr.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2023 Jun; Vol. 115 (6), pp. 1403-1410. Date of Electronic Publication: 2022 May 26.
DOI:	10.1016/j.athoracsur.2022.04.058
Abstrakt:	Background: Valve-sparing aortic root replacement with the David procedure is an alternative to the Bentall procedure in patients with aortic root aneurysm. The aim of this study was to describe our long-term experience with this technique and the predictive factors of late failure. Methods: Between January 1998 and August 2019, 300 consecutive patients underwent a David procedure. Clinical and echocardiographic early- and long-term outcomes were analyzed. Median follow-up was 7.0 years (range, 4.1-11.5), with 98.3% complete. Results: Early mortality was 1%. No early valve-related reoperations occurred. There were 9 cardiac-related deaths and 22 reinterventions (19 valve-related). All patients survived reoperation. In 3 patients reintervention consisted of transcatheter aortic valve implantation. Overall survival rates were 95.3% (95% confidence interval [CI], 92.0-97.2), 91.1% (95% CI, 86.5-94.2), and 82.9% (95% CI, 75.3-88.4) at 5, 10, and 15 years, respectively. Freedom from postoperative aortic insufficiency (AI) grade ≥ 2 was 84.8% (95% CI, 79.9-88.6) and 74.3% (95% CI, 67.4-79.9) at 5 and 10 years, respectively. Freedom from reintervention for aortic valve disease was 97.1% (95% CI, 94.2-98.5), 92.9% (95% CI, 88.2-95.7), and 92.5% (95% CI, 87.1-95.7) at 5, 10, and 15 years, respectively. Preoperative AI ≥ 2 (hazard ratio, 1.782; 95% CI, 1.352-2.350) and a ventriculoaortic junction ≥ 29 mm (hazard ratio, 3.379; 95% CI, 1.726-6.616) were predictive factors for postoperative AI ≥ 2 in a multivariate analysis (P < .001). Conclusions: Preoperative AI ≥ 2 and a ventriculoaortic junction ≥ 29 mm were identified as risk factors for late postoperative AI ≥ 2. (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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