A Comparison of Two Strategies for Aortic Valve-sparing Root Replacement

Colleagues from Italy and Germany compared the short- and mid-term outcomes of the straight tube graft (David-I) and the Valsalva graft in 232 patients undergoing an isolated David procedure. The two groups did not differ significantly in 30-day mortality (1% vs 2%), late survival (p = 0.799), or valve-related reoperation (p = 0.241). Although with more cusp repairs (22% vs 4%), patients with Valsalva graft showed a higher incidence of aortic insufficiency ≥ II° after surgery (17% vs 0%) and at follow-up (39% vs 22%). This study also identified bicuspid aortic valve (OR = 3.435, p = 0.005) and postoperative aortic insufficiency ≥ II° (OR = 5.988, p < 0.001) as risk factors for reoperation on the aortic valve.