Long term clinical and echocardiographic follow-up after the David- and Yacoub- procedure

Objectives: Aortic valve preserving techniques are performed according to the reimplantation (David) and remodeling techniques (Yacoub) or their modifications. For final judgement of these operations, long term follow-up is mandatory.

Methods: From July 1993 to July 2005, 164 consecutive patients underwent 68 David-operations (group D; 41%) and 96 Yacoub-operation (group Y; 59%). Mean age was 50±16 years in group D (73% male) and 56±15 years in group Y (63% male); p=n.s. Underlying diseases were acute type A aortic dissection (n=56), aneurysm ≥4.5cm (n=130), and Marfan's syndrome (n=30), re-spectively.

Results: Completeness of follow-up was 100%. Mean clinical follow-up was 4.0±2.9 years, range 0.1 to 12.7 years. Probability of overall survival in group D at 12.7 years was 80.0±8.0% and in group Y at 9.4 years 80.0±5.0%. Indication for valve related re-operation was aortic regurgitation (AR) in eight patients (n=1 in group D and n=7 in group Y; p=n.s.). Of these, 3 patients had acute type A aortic dissections and use of glutaraldehyde (GFR) glue for aortic root reconstruction. Freedom from aortic valve related re-operation was 97.8±4.3% in group D and 88.7±8.5% in group Y (p=n.s.). Mean transvalvular pressure gradient was 5.4±4.7mmHg (D: 6.0±4.8mmHg; Y: 5.0±4.7mmHg; p=n.s.). Overall grade of AR was: grade I: 24%, grade II: 3.0%, grade III: 4.3% (D: 17.6%, 2.9%, 1.5%, and Y: 28.4%, 3.2%, and 6.3%, respectively).

Conclusions: Both techniques offer excellent long-term valve performance and survival. The slightly higher rate of valve related re-operations with the remodeling technique may be related to technical details.