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David Procedure — EECC MCQ

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ModerateAortic DiseaseDavid ProcedureEECC

A 55-year-old man with a known 5.5 cm ascending aortic aneurysm associated with a bicuspid aortic valve undergoes surgery. The surgeon performs a valve-sparing aortic root replacement (David procedure). What does this operation involve?

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Correct answer: D — The David procedure replaces the aneurysmal aortic root and ascending aorta with a vascular graft while preserving the native aortic valve by reimplanting it within the graft — avoiding the need for lifelong anticoagulation

The David procedure (valve-sparing root replacement / reimplantation technique) preserves the native aortic valve cusps while replacing the diseased aortic root and ascending aorta with a Dacron vascular graft. The native valve is reimplanted within the graft at a neo-annulus. Advantages: (1) avoids mechanical valve and lifelong anticoagulation; (2) avoids bioprosthetic valve degeneration; (3) preserves native valve haemodynamics. It is most suitable when: (1) valve cusps are morphologically normal (no significant calcification or retraction); (2) the pathology is primarily root dilatation (Marfan, BAV aortopathy); (3) performed by experienced surgeons. The alternative (Bentall procedure) uses a composite mechanical valve-graft conduit requiring lifelong anticoagulation. The 2024 ESC Aortic Disease Guidelines recommend valve-sparing surgery at experienced centres when feasible.

Reference: ESC (2024): Aortic Disease Guidelines; ESC/EACTS (2025): VHD Guidelines