loading page

Current trends in minimally invasive valve-sparing aortic root replacement -- best available evidence
  • +1
  • Davorin Sef,
  • Toufan Bahrami,
  • Shahzad Raja,
  • Tomislav Klokocovnik
Davorin Sef
Department of Cardiac Surgery Harefield Hospital Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ NHS Foundation Trust London United Kingdom
Author Profile
Toufan Bahrami
Department of Cardiac Surgery Harefield Hospital Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ NHS Foundation Trust London United Kingdom
Author Profile
Shahzad Raja
Department of Cardiac Surgery Harefield Hospital Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ NHS Foundation Trust London United Kingdom
Author Profile
Tomislav Klokocovnik
Department of Cardiovascular Surgery University Hospital Center Ljubljana Ljubljana Slovenia EU
Author Profile

Abstract

Background: Valve-sparing aortic root replacement such as the re-implantation (David) procedure is becoming increasingly popular. Despite the fact that the procedure is technically more complex, long-term studies demonstrated that excellent clinical outcomes in selected patients with durable repair are achievable. Benefits of minimal access cardiac surgery have stimulated enthusiasm in the use of this approach for valve-sparing aortic root replacement. Methods: We have reviewed available literature on the topic of valve-sparing aortic root replacement (David procedure) via minimally invasive approach through upper hemisternotomy in an attempt to assess current trends and to recognize potential advantages of this technique. Patient selection and preoperative work-up play important role in performing minimally invasive David procedure safely. Surgical technique is similar to the standard David procedure, with several exceptions, and is performed via upper hemisternotomy. Results and Conclusion: Evidence from non-randomized observational and comparative studies demonstrated excellent clinical outcomes of minimally invasive David procedure in selected patients with comparable perioperative mortality to the conventional technique. To date, elective David procedure with a minimal access technique has been performed in low- and intermediate-risk patients. We believe that minimally invasive David procedure could be particularly useful in young patients (Marfan syndrome, bicuspid AV) as it allows faster recovery with improved cosmesis. A decision to perform minimally invasive David procedure should be individualized to each patient and based on the experience of the team. Further large prospective randomized studies with long-term follow-up are still needed to confirm durability of minimal access technique.
10 Jan 2022Submitted to Journal of Cardiac Surgery
10 Jan 2022Submission Checks Completed
10 Jan 2022Assigned to Editor
17 Jan 2022Reviewer(s) Assigned
02 Feb 2022Review(s) Completed, Editorial Evaluation Pending
16 Feb 2022Editorial Decision: Revise Minor
20 Feb 20221st Revision Received
21 Feb 2022Submission Checks Completed
21 Feb 2022Assigned to Editor
21 Feb 2022Reviewer(s) Assigned
03 Mar 2022Review(s) Completed, Editorial Evaluation Pending
05 Mar 2022Editorial Decision: Accept
Jun 2022Published in Journal of Cardiac Surgery volume 37 issue 6 on pages 1684-1690. 10.1111/jocs.16453