Midterm follow-up dynamic echocardiography evaluation after ascending aorta replacement and reimplantation of the aortic valve (David operation) in a matched control study.

OBJECTIVE: Dynamic performance of the aortic valve (AV) after ascending aorta replacement with reimplantation of the native AV (David) was investigated.
METHODS: We prospectively evaluated 17 patients who underwent David procedure. Rest/stress echocardiography follow-up was performed and results were compared with those of matched healthy controls.
RESULTS: There were no significant differences in terms of age, height, weight, BSA, left ventricular mass, left ventricular ejection fraction (LVEF) and tele-diastolic volume between the David and control group. At rest echocardiography, patients in the David group had a lower indexed aortic valve area (IAVA) (1.1 ± 0.2 vs. 1.5 ± 0.2 cm(2)/m(2), P < 0.0001), with comparable transvalvular gradients (TVG). At maximal physical stress, although the IAVA in the David group was significantly increased from the rest values (P = 0.001), the difference with the control group persisted (David 1.4 ± 0.3 vs. Control 1.7 ± 0.2 cm(2)/m(2), P < 0.0001) maintaining similar peak TVG (David 13.6 ± 5.3 vs. Control 11.7 ± 4.5 mmHg, P = ns) and mean TVG (David 7.2 ± 3.0 vs. 6.2 ± 2.4 mmHg, P = ns). AV regurgitation in the David group was absent in five (29.4%), grade I in nine (52.9%) and grade II in three (17.6%) patients and remained unchanged during stress. At multiple linear regression, David operation was inversely correlated to rest IAVA (OR = -0.4; P = 0.01; CI: -0.7-0.1).
CONCLUSIONS: Although IAVA is significantly smaller after David procedure in comparison with matched controls, no pathological increase in TVG is noticed. A significant increase in the IAVA during physical stress documents the preserved pliability/elasticity of the aortic unit after David procedure preventing pathological increase in the TVG even during strenuous effort.