{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:55:36Z","timestamp":1790704536632,"version":"4.1.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T00:00:00Z","timestamp":1678406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Aortic valve-sparing root replacement (AVSRR) is a technically demanding procedure. In experienced centers it offers excellent short- and long-term results, making the procedure an attractive alternative for aortic root replacement especially in young patients. The aim of this study was to analyze long-term results of AVSRR using the David operation in our institution over the last 25 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a single-center retrospective analysis of outcomes of David operations performed in a teaching institution not running a large AVSRR-program. Pre-, intra- and postoperative data were collected from the institutional electronic medical record system. Follow-up data were collected through direct contact of the patients and their cardiologists\/primary care physicians.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between 02\/1996 and 11\/2019, 131 patients underwent David operation in our institution by a total of 17 different surgeons. Median age was 48 (33\u201359), 18% were female. Elective surgery was performed in 89% of the cases, 11% were operated as emergency in the setting of an acute aortic dissection. Connective tissue disease was present in 24% and 26% had a bicuspid aortic valve. At hospital admission 61% had aortic regurgitation grade \u22653, 12% were in functional NYHA-class \u2265III. 30-day mortality was 2%, 97% of the patients were discharged with aortic regurgitation \u22642. In 10-year follow-up, 15 (12%) patients had to be re-operated because of root-related complications. Seven patients (47%) received a transcatheter aortic valve implantation, 8 (53%) required surgical replacement of the aortic valve or a Bentall-De Bono operation. Estimated reoperation-free survival at 5 and 10 years was 93.5%\u2009\u00b1\u20092.4% and 87.0%\u2009\u00b1\u20093.5%, respectively. Subgroup analysis showed no differences in reoperation-free survival for patients presenting with a bicuspid valve or preoperative aortic regurgitation \u22653. However a preoperative left ventricular end diastolic diameter of \u22655.5\u2005cm was associated with worse outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>David operations can be performed with excellent perioperative and 10-year follow-up outcomes in centers not running large AVSRR-programs.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1104149","type":"journal-article","created":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T05:46:50Z","timestamp":1678427210000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Twenty-five year experience with aortic valve-sparing root replacement in a single teaching center"],"prefix":"10.3389","volume":"10","author":[{"given":"Juri","family":"Sromicki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Van Hemelrijck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin O.","family":"Schmiady","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Greutmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Bonassin Tempesta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos-A.","family":"Mestres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul R.","family":"Vogt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry P.","family":"Carrel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom\u00e1\u0161","family":"Holubec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1136\/thx.23.4.338","article-title":"A technique for complete replacement of the ascending aorta","volume":"23","author":"Bentall","year":"1968","journal-title":"Thorax"},{"key":"B2","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1161\/CIRCULATIONAHA.113.002475","article-title":"Repair of the regurgitant bicuspid or tricuspid aortic valve: background, principles, and outcomes","volume":"128","author":"Kari","year":"2013","journal-title":"Circulation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/S0022-5223(19)34942-6","article-title":"An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta","volume":"103","author":"David","year":"1992","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1588","DOI":"10.1093\/ejcts\/ezv427","article-title":"Aortic root haemodynamics following david procedure: numerical analysis of 3-dimensional haemodynamics","volume":"49","author":"Berdajs","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1016\/j.jtcvs.2014.04.048","article-title":"A quarter of a century of experience with aortic valve-sparing operations","volume":"148","author":"David","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1097\/imi.0b013e31824641d7","article-title":"Techniques of aortic valve repair","volume":"6","author":"Rankin","year":"2011","journal-title":"Innovations"},{"key":"B7","doi-asserted-by":"publisher","first-page":"966126","DOI":"10.3389\/fcvm.2022.966126","article-title":"Valve-sparing david procedure via minimally invasive access does not compromise outcome","volume":"9","author":"Shrestha","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. 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