{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T16:02:13Z","timestamp":1778601733687,"version":"3.51.4"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2020,5,14]],"date-time":"2020-05-14T00:00:00Z","timestamp":1589414400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p\/>\n                  <jats:p>The aim of this study was to evaluate whether additional cusp interventions and valve types affect aortic valve-related reoperation and mortality rates after the David procedure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Between 1997 and 2018, a total of 449 patients {372 males; mean age 54.2 [standard deviation (SD) 15.2] years, range: 12.7\u201379.9\u2009years} underwent elective valve-sparing aortic root replacement (David procedure) for aortic regurgitation and were prospectively followed up clinically and echocardiographically.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>The follow-up was 94% complete. Cumulative follow-up time was 2268 patient-years [mean follow-up time 5.1 (4.3 SD) years]. Thirty-day mortality was 2.2% (n\u2009=\u200910). Late (&amp;gt;30\u2009days) survival did not differ from that of the age- and gender-matched general population. Freedom from reoperation in patients without additional cusp reconstruction was 94% [95% confidence interval (CI) 91\u201398] and 92% (95% CI 88\u201397) at 5 and 10\u2009years, respectively, which was not significantly different (P\u2009=\u20091) for patients who did require additional cusp reconstruction 98% (95% CI 95\u2013100) and 89% (95% CI 81\u201399). In patients with tricuspid aortic valves (n\u2009=\u2009338), freedom from reoperation was 96% (95% CI 94\u201399) and 93% (95% CI 88\u201397) at 5 and 10\u2009years, respectively. Patients with bicuspid aortic valves (n\u2009=\u2009111) had a freedom from reoperation of 94% (95% CI 89\u201399) at 5\u2009years and 88% (95% CI 79\u201398) at 10\u2009years (P\u2009=\u20090.021 for the comparison to tricuspid aortic valve). Overall, 23 patients (5%; 1%\/patient-year) required reoperation with a mean interval of 4.5 (4.8 SD) months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>The David procedure revealed low mid-term reoperation risk and excellent survival independent of adjunctive cusp interventions\/valve morphology and is comparable with that of the age- and gender-matched general population.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaa149","type":"journal-article","created":{"date-parts":[[2020,4,8]],"date-time":"2020-04-08T03:34:45Z","timestamp":1586316885000},"page":"1072-1079","source":"Crossref","is-referenced-by-count":5,"title":["Additional cusp reconstruction does not compromise valve durability and mid-term survival after the David procedure: results from 449 patients"],"prefix":"10.1093","volume":"58","author":[{"given":"Markus","family":"Liebrich","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Sana Cardiac Surgery, Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Efstratios","family":"Charitos","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital, Bonn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Stadler","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Sana Cardiac Surgery, Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Detlef","family":"Roser","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Sana Cardiac Surgery, Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denis R","family":"Merk","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Sana Cardiac Surgery, Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Doll","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Sana Cardiac Surgery, Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Hemmer","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Sana Cardiac Surgery, Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vladimir","family":"Voth","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Sana Cardiac Surgery, Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,5,14]]},"reference":[{"key":"2020102110251873200_ezaa149-B1","doi-asserted-by":"crossref","first-page":"94","DOI":"10.21037\/jovs.2018.04.12","article-title":"Biological solutions to aortic root replacement: valve-sparing versus bioprosthetic conduit","volume":"4","author":"De Paulis","year":"2018","journal-title":"J Vis Surg"},{"key":"2020102110251873200_ezaa149-B2","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/j.athoracsur.2017.08.040","article-title":"Elective David I procedure has excellent long-term results","volume":"105","author":"Shrestha","year":"2018","journal-title":"Ann Thorac Surg"},{"key":"2020102110251873200_ezaa149-B3","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1093\/icvts\/ivv354","article-title":"Survival and freedom from aortic valve-related reoperation after valve-sparing aortic root replacement in 1015 patients","volume":"22","author":"Kari","year":"2016","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2020102110251873200_ezaa149-B4","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.athoracsur.2012.08.010","article-title":"The David procedure in different valve pathologies. 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