Twenty-year experience of aortic valve reimplantation using the Valsalva graft: a successful technique with well-made device!

Abstract

The introduction of the aortic valve (AV) reimplantation, also called David procedure, by David and Feindel in 1992 have placed a milestone for AV sparing [1]. This, one of the most 2 important valve-sparing aortic root replacement operations became the standard technique for patients with aortic root aneurysm with or without AV regurgitation with excellent short- and long-term results [2]. Over the years, the surgical technique of AV reimplantation has evolved significantly from the originally described technique aiming to mimic the anatomical form of the aortic root. Many modifications, including the ‘so-called’ David I–V operations, using different techniques such as plication stitches to create pseudo-/neo-sinuses [3, 4], 2 cylindrical grafts [5] or even special anatomically designed bulged grafts [6] have been described. In this issue of the European Journal of Cardiothoracic Surgery, Chirichilli et al. describe their 20-year-long experience with AV reimplantation using the Gelweave Valsalva graft Vascutek Ltd, Terumo Company (Renfrewshire, Scotland, UK) in 265 patients with aortic root aneurysm with or without AV regurgitation [7]. This device has been designed and invented by the senior author of the current article De Paulis [6] at the end of the last millennium and implemented in the routine practise at the beginning of 2000. The presented study belongs to the largest published cohorts describing AV reimplantation with this graft. The early- and long-term outcomes (mean of 7.1 years) are excellent. The overall survival at 15 years was 87.6 ± 3.4% and freedom from cardiac death was excellent and stable at 99.6 ± 0.4% up to 15 years. Freedom from recurrent AR ≥moderate and freedom from reoperation remained stable up to 15 years at 92.2 ± 2.1% and 95.9 ± 1.6%, respectively. In addition, the incidence of infective endocarditis, thromboembolism and haemorrhage was extremely low. Importantly, a clear message that can be derived from this paper is that David procedure using this particular graft is an excellent and durable option for the surgical treatment of the patients with aortic root aneurysm with or without AV regurgitation. The authors also report that long-term results might have improved after the implementation of routine performance of AV analysis with calliper.