P001. 21-year Experience with David Procedure in a Middle-income Country Setting
Fundacion Cardioinfantil
Bogota DC
Colombia - Contact Me
I am a recent graduate specializing in cardiac surgery with a strong passion for innovative and endovascular procedures, particularly in the fields of complex arch and thoracoabdominal aortic surgery. Throughout my fellowship, I have diligently honed my medical and surgical skills, while also gaining invaluable experience working collaboratively within a team environment. This comprehensive training has equipped me to provide patients with the highest standard of care, delivered with both expertise and compassion.
Having served as the principal surgeon in over 100 surgeries, including procedures such as coronary artery bypass grafting, aortic and mitral valve replacement, Bentall operations, descending thoracic aorta replacement, and hemiarch surgeries, I have successfully managed a diverse range of cases. Additionally, I have had the privilege of assisting in over 1200 surgeries, notably contributing to complex procedures like aortic arch replacement, thoracoabdominal aortic replacement, Ross and David procedures.
My extensive experience as both a principal surgeon and an assisting physician has nurtured my ability to handle intricate surgical techniques with precision and care. I am committed to staying at the forefront of advancements in cardiac surgery, ensuring that my patients in Colombia receive the most effective and innovative treatments available.
By combining my exceptional technical skills with a compassionate approach, I strive to provide patients with not only exceptional medical outcomes but also a sense of comfort and understanding during their journey towards recovery.
Description
Methods: We included all patients who underwent the David procedure from January 2002 to September 2023 at our institution. We identified patients using the institutional cardiac surgery database that follows the coding guidelines of the Society of Thoracic Surgeons (STS). We collected demographics, clinical and imaging data from pre-, intra- and post-operative periods. Patient follow-up was done through outpatient clinic, government databases and telephone interviews. Our main outcomes were survival rate, valve regurgitation recurrence and freedom from reoperation, estimated by the Kaplan-Meier method. The bivariate analyses were done using the Mann-Whitney U test and the Chi-square or Fisher´s exact test according to the nature and distribution of each variable
Results: A total of 170 patients between 14 and 72 years of age were identified in 21 years of experience. Median age was 51 years (IQR 39-59), 82% of the patients were male and the most frequent comorbidity was hypertension (39%). Marfan´s syndrome was present in 14% of patients and 38% had bicuspid aortic valve. The indication of the procedure was an aortic aneurism in 84% of cases and aortic dissection in 12%. Preoperative aortic regurgitation (AVR) was grade IV in 52% of patients, grade III in 13% and grade II in 6%. Most patients underwent elective surgery (57%), followed by urgent priority (38%) and 4% were emergencies. The concomitant procedures were aortic valve repair in 20 patients, aortic arch repair in 22 patients, mitral valve repair in 12 patients and Maze procedure in 3 patients. There were 2 perioperative deaths. At a mean follow-up of 3 years, 95% of patients were free of significant aortic regurgitation. Freedom from hemodynamically significant AVR (Grade III or higher) was estimated at 96% at 108 months. Freedom from reoperation was 95% at 13 years and there was a total of 7 valve related reoperations. Survival estimate was 83% after 15 years of follow-up.
Conclusions: Aortic valve-sparing root replacement is a safe procedure providing excellent short and long-term outcomes. The improvement of AVR was remarkable and maintainable in the long term. In our setting, the David procedure shows excellent outcomes comparable to the reported in high-volume income centers.
Authors
Julian Senosiain (1), Jaime Camacho (2), Juan Umaña (3), Nicolas Nunez-Ordonez (1), Juan David Niño (4), Carlos Villa (5), TOMAS Chalela (6), NESTOR SANDOVAL (7), Carlos Obando (8)
Institutions
(1) N/A, N/A, (2) Fundacion Cardioinfantil, Bogota, NA, (3) Cleveland Clinic, Ohio, USA, (4) Universidad del Rosario, Bogota, NA, (5) Fundacion Cardioinfantil, Bogota, Colombia, (6) N/A, bogota, Colombia, (7) FUNDACION CARDIOINFANTIL, BOGOTA, DC, (8) N/A, Bogota, Colombia