Valve-Sparing Aortic Root Surgery

Types of patients receiving valve-sparing aortic root surgery (David or Yacoub procedures)

This procedure is used for patients who have aneurysms of the aortic root or more frequently of the aortic root and the ascending aorta when the aortic valve leaflet tissue is of good quality. Patients with tricuspid or bicuspid aortic valves may be candidates for this operation provided that the valves are not calcified or fibrotic and that they do not have multiple fenestrations in multiple leaflets. Also, the presence of aortic valve regurgitation is not a contraindication to the operation provided that the leaflets can be repaired. This operation can benefit patients with Marfan disease and young patients with normal aortic valve leaflets.

During this operation, the aortic sinuses are removed, and the aortic valve commissures with the leaflets are reimplanted inside a synthetic tube graft. The presence of aortic valve regurgitation is not a contraindication for the operation because the leaflets can be effectively repaired after the root has been replaced. The coronary arteries that are initially disconnected from the aortic sinuses are connected back to the tube graft. 

Valve preservation removes need for artificial valve or anticoagulants

Utilizing this technique the native aortic valve is preserved, avoiding the need for artificial valve and anticoagulants (medications that stop blood from clotting).

Main Line Health has significant experience with aortic valve repair and aortic valve-sparing procedures. There were no mortalities or strokes in this series of patients. Most importantly the incidence of reoperation for recurrent aortic valve regurgitation has been very low in the last ten years.

What to expect before, during and after aortic surgery