What is David’s Surgery and Which Patients Does It Apply to?

What is David’s Surgery and Which Patients Is It Performed?

The aortic root is the area that connects the aorta to the left ventricle, the heart’s main pumping chamber, and contains the aortic valve. The aortic valve manages the flow of blood from the left ventricle to the aorta. David’s surgery is an operation to correct problems with the aortic root and aortic valve, in which the aortic valves are preserved. This technique is usually applied in cases of aortic dissection, aortic aneurysm, aortic valve insufficiency. The main purpose of David surgery is to preserve the aortic valve while replacing the aortic root. Thus, the function of the patient’s own natural aortic valve can continue.

In order to be a candidate for this operation, the condition of your aortic valve must be in the following conditions:

• It works properly or can be repaired.
• There is little or no calcium deposition (calcification).
• Absence of valve stenosis and severe regurgitation. Mild to moderate insufficiency can be tolerated.

How is David’s Surgery Performed?

1. The sternum is opened by cutting it in half or, as we do, the sternum is entered under the armpit between the ribs. In this method, the sternum remains intact.
2. The enlarged aortic vessel is removed together with the aortic sinuses and the exit points of the coronary vessels from the aorta are prepared by cutting them in a button style. The aortic valves remain in place.

• Dacron synthetic graft suitable for aortic root width is prepared.

1. The aortic root is reconstructed with a synthetic graft.
2. The aortic valves are implanted to the new Dacron graft together with the surrounding tissues by continuous suturing and the commissure attachment sites are fixed to the Dacron graft.
3. The coronary vessels are sutured to the ostium opened to the Dacron graft and the aortic root replacement is completed.

• The distal anastomosis of the Dacron graft is anastomosed to the intact aortic tissue or to a second Dacron graft and the procedure is completed.

Postoperative Process

Most patients can return to their daily activities within a few weeks after surgery by cutting the breastbone. However, full recovery may take several months. In the underarm method, the patient’s return to daily activities and work is faster than open surgery. The patient can return to work and normal life in 15-20 days after discharge. In addition, the need for lifelong anticoagulant (blood thinner) use is reduced and the risks of complications caused by artificial valves are minimised. Patients use low-dose aspirin for 3-6 months after surgery and no blood thinners are required afterwards.

How Successful Is David’s Surgery?

• The aortic root and valve are successfully repaired in more than 95% of cases.
• The rate of survivors is over 99 per cent.
• Depending on the condition of your valve, you will probably not need another aortic valve operation. Most people (92% to 98%) do not need it within 10 years after surgery.
• Approximately 95% of people with tricuspid aortic valve anatomy or connective tissue defects do not need aortic valve surgery again after 10 years and do not experience severe aortic valve insufficiency.

Which Patients Is David’s Surgery Performed?

• Patients with aortic root aneurysm: Patients with enlargement or ballooning of the aortic root are at risk of aneurysm rupture.
• People with genetic connective tissue diseases: People with genetic connective tissue diseases such as Marfan syndrome, Loeys-Dietz syndrome or Ehlers-Danlos syndrome are at risk of aortic root dilatation.
• Aortic root enlargement with aortic valve insufficiency: With David’s operation, the aortic root is corrected and the aortic valve is protected to prevent backflow of blood.
• Patients with aortic root dissection: Aortic dissection is a rupture of the aortic wall, with blood travelling between the layers of the aortic wall.

David’s surgery is a safe and effective surgical technique for treating aortic valve and aortic root problems. Preservation of the patient’s own natural aortic valve improves postoperative quality of life and reduces the risk of long-term complications. Before deciding on surgery, it is important for patients to consult a Cardiovascular Surgery specialist who can perform these operations and has experience with the underarm method, and to get detailed information about the risks and benefits of the surgery.