The Yacoub Technique Is Superior to the David Procedure in Terms of Functional Performance under States of Increased Cardiac Output—An Ex Vivo Study

Background: The David reimplantation and Yacoub remodeling technique are commonly performed for valve sparing aortic root replacement. The objective was to compare these two procedures in terms of functional performance under states of increased cardiac output using a standardized ex vivo model.

Methods: David and Yacoub procedures were performed on n = 15 swine aortic roots. The roots were placed inside a pulse duplicator to evaluate mean pressure gradient (MPG) and effective orifice area (EOA) over a large range of stroke volume. Furthermore, diameter changes of the aortic annulus and sinotubular junction were measured using ultrasonic crystals. In addition to the David and Yacoub groups, the native aortic valve was also evaluated.

Results: The native valve and Yacoub valve showed a similar increase of MPG with increasing flow through the valve (p = 0.92). On the contrary, the David valve showed a higher increase of MPG with flow compared with the native (p = 0.04) and Yacoub valve (p = 0.02). Similarly, the David valve showed a weaker increase of EOA with increasing flow, though this difference was not statistically significant (vs. Yacoub p = 0.70, vs. native p = 0.89). The native valve showed the greatest increase of aortic root diameter with increasing flow, followed by the Yacoub valve and finally the David valve.

Conclusion: Our results indicate that the Yacoub procedure may be superior to the David valve in terms of functional performance under states of increased exercise. As the David valve simultaneously showed a weaker increase of aortic root diameter, surgical support of the annulus is the most likely explanation. These findings may have an influence on patient outcomes, especially in physically active patients, and may influence the choice of surgery in some patients.

Publication History

Article published online:
13 February 2024