Valve-sparing aortic root replacement (David procedure)

What is valve-sparing aortic root replacement (David procedure)?

Valve-sparing aortic root replacement, also known as the David procedure, is a surgical technique used to treat aortic root aneurysms while preserving the patient’s native aortic valve. It’s performed to prevent complications such as aortic dissection or rupture while maintaining normal valve function. Unlike traditional aortic root replacement, which involves replacing the valve with a mechanical or biological prosthesis, the David procedure retains the patient’s own valve, which can reduce the need for lifelong anticoagulation therapy.

How does it work?

The procedure involves removing the diseased portion of the aortic root while preserving the aortic valve. The surgeon then replaces the affected section of the aorta with a synthetic graft and reimplants the patient's aortic valve within the graft. This ensures that the aorta remains structurally sound while allowing the valve to continue functioning naturally. By maintaining the patient’s own valve, the operation avoids the complications associated with artificial valve replacements, such as the need for long-term blood-thinning medication.

What's involved in valve-sparing aortic root replacement?

The David procedure is an open-heart operation performed under general anaesthesia. The patient is placed on a heart-lung bypass machine to temporarily take over the function of the heart and lungs. The surgeon makes an incision in the chest to access the aortic root, removes the aneurysmal section, and carefully preserves the aortic valve. A synthetic graft is then sewn into place, and the native valve is repositioned inside the graft to restore proper blood flow. The coronary arteries are reattached to the graft, and the heart is restarted before closing the chest. The procedure typically takes several hours, followed by close monitoring in an intensive care unit.

How can I prepare for valve-sparing aortic root replacement?

Preparation for surgery involves several steps, including preoperative assessments and lifestyle adjustments. Patients typically undergo imaging studies such as echocardiography, CT scans or MRI to assess the condition of the aortic root and valve. Routine blood tests, electrocardiograms, and lung function tests may also be performed. Patients are advised to stop smoking, maintain a balanced diet, and manage any existing health conditions, such as high blood pressure or diabetes, to optimise their recovery. Medications that affect blood clotting may need to be adjusted before surgery.

What happens in recovery from the David procedure?

Following surgery, patients spend time in an intensive care unit for close monitoring. Pain management and breathing support are provided as needed. Most patients are encouraged to start moving as soon as possible to prevent complications such as blood clots and pneumonia. The hospital stay typically lasts around one to two weeks, depending on individual recovery. Cardiac rehabilitation, including supervised exercise and lifestyle guidance, is recommended to support long-term recovery. Follow-up appointments with a cardiac surgeon and imaging tests are required to monitor the function of the repaired aorta and valve over time.

Which specialist performs the David procedure?

A cardiac and aortic surgeon with expertise in complex aortic surgery performs the David procedure. These specialists are highly trained in advanced heart and vascular surgeries, particularly those involving the aortic root and valve structures. The procedure is typically carried out in specialised cardiac centres with dedicated surgical teams experienced in aortic repair and reconstruction.