David reimplantation with simultaneous total arch replacement and stented elephant trunk for acute type A aortic dissection

Objectives: To compare early and mid-term outcomes between David reimplantation and the Bentall procedure with simultaneous total arch replacement (TAR) and stented elephant trunk (SET) implantation in acute type A aortic dissection (ATAAD). Methods: From January 2012 to June 2018, 148 patients underwent aortic root replacement combined with TAR and SET for ATAAD. Patients were evaluated retrospectively and categorized into David reimplantation (n = 55) and Bentall procedure (n = 93) groups. Propensity-matched analysis was performed to compare in-hospital and follow-up adverse events between the 2 groups. Results: In-hospital mortality and the incidence of major perioperative complications were comparable between the 2 groups (all P>.05). No significant difference in mean cardiopulmonary bypass time and circulatory arrest time was found between the 2 groups, although mean crossclamp time was longer in the David group (P = .02). During a follow-up period of 2.6 (interquartile range, 1.5-4.3) years, the Bentall group experienced rates of paravalvular leakage and prosthetic valve endocarditis of 2.3% and 2.3%, respectively, whereas the David group experienced rates of infective endocarditis and recurrent moderate aortic regurgitation of 1.9% and 1.9%, respectively. The overall survival was 82.9% for the David group and 89.2% for the Bentall group (P = .63), whereas the incidence of major cardiovascular-related events was 21.3% and 17.3% (P = .30) 5 years postoperatively. Conclusions: For Chinese patients undergoing ATAAD, David reimplantation provided similar outcomes compared with the Bentall procedure, with simultaneous TAR and SET. David reimplantation is an appealing option for patients who suffer root ectasia or extensive sinus damage albeit normal leaflets.