Valve-sparing David procedure minimally invasive access does not compromise outcome.

Objectives: Aortic valve sparing-aortic root replacement (David procedure) has not been routinely performed minimally invasive access due to its complexity. We compared our results of elective David procedure minimally invasive access to those a full sternotomy.

Methods: Between 1993 and 2019, a total of 732 patients underwent a valve sparing root replacement (David) procedure. Out of these, 220 patients underwent elective David-I procedure (isolated) without any other concomitant procedures at our center. Patients were assigned to either group A ( = 42, mini-access) or group B ( = 178, full sternotomy).

Results: Cardiopulmonary bypass time were 188.5 ± 35.4 min in group A and 149.0 (135.5-167.5) in group B ( < 0.001). Aortic cross-clamp time were 126.2 ± 27.2 min in group A and 110.0 (97.0-126.0) in group B ( < 0.001). Post-operative echocardiography showed aortic insufficiency ≤ I° in 41 (100%) patients of group A and 155 (95%) of group B. In-hospital mortality was 2.4% ( = 1) in group A and 0% ( = 0) in group B ( = 0.191). Perioperative stroke occurred in 1 (2.4%) patient of group A and 2 (1.1%) patients of group B ( = 0.483). Reexploration for bleeding was necessary in 4 (9.5%) patients of group A and 7 (3.9%) of group B ( = 0.232). Follow-up was complete for 98% of all patients. The 1-, 2-, 4-, and 6-year survival rates were: 97, 97, 97, and 97%, in group A (mini-access) and 99, 96, 95, and 92% in group B (full sternotomy), respectively. The rates for freedom from valve-related re-operation at 1, 2, 4, and 6 years after initial surgery were: 97, 95, 95, and 84% in group A and 97, 95, 91, and 90% in group B, respectively.

Conclusion: Early post-operative results after David procedure minimally invasive access are comparable to conventional full sternotomy. Meticulous attention to hemostasis is a critical factor during minimally access David procedures. Long-term outcome including the durability of the reimplanted aortic valve seems to be comparable, too.