Valve-Sparing Aortic Root Replacement (David Procedure) With Two-Vessel CABG: A Case Report With Early Recovery

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 This case involves a 62-year-old male patient who underwent valve-sparing aortic root replacement (the David procedure) in combination with two-vessel coronary artery bypass grafting. Preoperative transthoracic echocardiography revealed a dilated aortic root with preserved left ventricular function and a normal ejection fraction. Intraoperative inspection confirmed the suitable anatomy of the native aortic valve, allowing for successful preservation. 
 
Preserving the native aortic valve avoids lifelong anticoagulation and reduces prosthetic valve-related complications, such as endocarditis and structural valve deterioration. It also improves hemodynamics and long-term outcomes, making it a preferred option for eligible patients, especially in younger or low-risk individuals. 
 
Two separate coronary bypass grafts were constructed using saphenous vein segments and were joined through an end-to-end anastomosis. Valve competence was confirmed intraoperatively with a water test. The patient was weaned from cardiopulmonary bypass without difficulty, extubated on the first postoperative day, and discharged on postoperative day six in stable condition. 
 
Follow-up echocardiography showed preserved native valve function and patent grafts with no complications. This case illustrates the safety and feasibility of combining complex aortic root surgery with coronary revascularization while emphasizing the importance of native valve preservation in selected patients. 

References

1. David TE, Feindel CM. An aortic valve–sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg. 1992;103(4):617–621.
2. El Khoury G, de Kerchove L, et al. Valve-sparing root replacement: remodeling and reimplantation techniques. Ann Cardiothorac Surg. 2013;2(1):113–121.
3. Yacoub MH, Cohn LH. Valve-sparing operations for aortic root aneurysms: a look into the future. Nat Clin Pract Cardiovasc Med. 2004;1(1):14–20.
4. Svensson LG, et al. Valve-sparing root replacement in patients with Marfan syndrome and other connective tissue disorders. J Thorac Cardiovasc Surg. 2007;133(1):181–187.
5. Benedetto U, et al. Aortic root replacement with or without coronary artery bypass grafting: a propensity-matched analysis. Eur J Cardiothorac Surg. 2015;47(3):507–513.

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