Valve sparing aortic root replacement surgery(David’s Procedure or VSARR)

What does this operation involve ?
As the name suggests in this operation,aneurysmal Aortic root is replaced with sparing of the native aortic valve. In conventional aortic root replacement surgery, aortic root replacement includes replacement of the ascending aorta , aortic root and aortic valve with reimplantation of coronary arteries. In VSARR , everything is similar to conventional aortic root replacement, except that instead of an artificial valve,the patient’s own aortic valve is used.

What are the advantages of VSARR over conventional aortic root replacement ?
VSARR is very similar to conventional aortic root replacement except that the patient’s own aortic valve is retained instead of replacing it with a mechanical or tissue valve. All artificial valves expose patients to an additional lifetime risk of stroke and infection . Mechanical valves have an added lifetime risk of bleeding while tissue valves may require future interventions. Patient’s native valves have a lower risk of the complications associated with artificial valves.

Am I a candidate for VSARR ?
Not everyone is suitable for VSARR. The native valve should be in good condition and anatomically suitable for reimplantation. Some patients are born with two leaflets instead of three but they can still have this operation as long as their leaflets are in good condition. The risk of failure increases if it is done in patients who are not suitable for VSARR. The surgeons who are experienced (more than 30 operations in their career) will advise you whether you are a suitable candidate for VSARR. To assess your candidacy for this operation your surgeon will organise a CT scan and transoesophageal echocardiogram after assessing your initial investigations.

What are the indications of VSARR ?
Typically this operation is done in patients who have an aortic root aneurysm with relatively normal structure of the aortic valve. Very experienced surgeons also perform this operation in patients with an acute tear in the aortic root. This operation is not suitable for patients with aortic root aneurysm with calcified aortic valve leaflets.

What is the aortic root ?
The aorta is the main pipe or tube that originates from the outflow portion of the left side of the heart. Through this tube the heart pumps blood into the entire body. As the aorta goes out further from the heart it gives branches to various parts of the body to supply blood to all organs. Part of the aorta within the chest is known as the “ Thoracic aorta” and the part in the abdomen is known as “ abdominal aorta” and hence the term thoracic aortic aneurysm or abdominal aortic aneurysm. The diameter of this tube varies between 3.0 to 4.0 cm and it varies according to height, gender and race of the patient. There is an outlet valve at the beginning of this tube which is known as the “aortic valve”. This valve, when functioning normally, is a one way valve meaning blood can only go out of the heart and cannot re-enter the heart chamber.

Aortic root – this part, as the name implies, is the very origin of the aorta from the heart. The aortic root includes origin of aorta, aortic valve-which is an outlet valve and the origin of the coronary arteries that supplies blood to heart muscle.

Do all heart surgeons perform this surgery ?
This operation is done by specialist aortic root surgeons. Different heart surgeons have different types of specialist interest in heart surgery. This surgery is quite complex and also uncommon. Only a handful of surgeons are experienced enough to carry out this surgery routinely. The experience and expertise is limited by the limited number of patients in the community.