Early Outcomes from 55 Consecutive Operations Using a Novel Valve Sparing Root Reimplantation Technique Well Suited for Complex Morphology

Structured Abstract Objective To describe a novel variation of the David reimplantation technique, which separates annuloplasty and commissuroplasty, valve reimplantation, and sinus reconstruction into discrete steps, and to evaluate early outcomes and aortic root morphology with emphasis on severe aortic insufficiency(AI) and bicuspid aortic valves(BAV). Methods From 12/2023 to 8/2024, 55 patients with aortic root aneurysms±AI underwent Deconstructed David at a single tertiary center. Ten patients(18%) had BAV, four(7%) had chronic dissection, and ten(18%) had genetic aortopathies. Preoperative AI was none in 19(36%), mild in 10(18%), moderate in 8(15%), and severe in 18(33%) patients. Mean annular diameter was 34±4.7 mm. Concomitant procedures included mitral repair(8, 15%), CABG(6, 11%), MAZE(6, 11%), tricuspid repair(4, 7%), and arch replacement(5, 9%). Root geometry and valve function were assessed by CT and echocardiography, with paired t-tests comparing pre- and postoperative dimensions. Results Mean cross-clamp time was 183±68 min. Median ICU stay was 2 days(IQR 1–4). There were no deaths. Complications included two non-disabling strokes, one transient neurologic deficit, and two early reoperations for bleeding. At discharge, 55(100%) had none/mild AI. 52 patients had echocardiography at ≥3 months, with 96.2% having none/mild AI and 3.8% having moderate/severe. Conclusions The Deconstructed David demonstrated excellent early valve competence even in patients with BAV and severe AI. This modular approach provides greater visualization after annuloplasty, reimplantation , and cusp repair; whether this improves repair quality or durability versus traditional reimplantation was not tested. Further research is essential to address long-term outcomes and durability as well as comparisons to traditional reimplantation.