What is valve sparing root replacement?

During valve-sparing root replacement (also called the David Procedure), the patient's aortic valve is kept, although it may be repaired and reimplanted, and reconnected to a graft. By preserving the native aortic valve, patients avoid the need for lifelong anticoagulation therapy with Coumadin and possibly have a valve that will last quite a bit longer than an animal valve replacement.

When the aorta is dilated, but the aortic valve leaflets are structurally normal, the aorta can be replaced ("root replacement") while preserving the aortic valve ("valve sparing"). This approach, known as a valve-sparing aortic root, avoids the need for a valve replacement with an artificial valve.  As a result, patients do not need blood-thinning medication that is required when the aortic valve is replaced with a mechanical valve.  Further, it is generally believed that by preserving the native aortic valve this approach offers a more durable fix than a bioprostheic ("tissue") valve.  However, because, it was first performed in the 1990s, long-term outcomes are lacking.

There are several variations of this procedure, but the "re-implantation" technique, also known as the "David procedure." is most widely used.  This procedure is often used to treat patients with aortic root aneurysms as a result of Marfans Disease.

In the operating room, the diseased aortic root tissue is excised.  Only the origins of the coronary arteries and aortic valve leaflets are left behind.  The aorta is replaced with a special collagen-coated, polyester graft.   The graft is then secured with sutures where the graft and heart meet. The aortic valve and then the origins of the coronary arteries are re-implanted within the graft. Finally, the opposite end of the graft is attached to the aortic arch.

Appropriate anatomy and advanced surgical techniques are required to ensure that the valve functions properly, and the repair is durable.  Therefore, this procedure should be performed by experienced centers on well-selected patients.