Current state of the reimplantation technique (DAVID Operation): surgical details and results

Valve-sparing operations are becoming more and more popular because they allow a repair of the native aortic valve and a replacement of the diseased aortic root and the ascending aorta. Previously these patients were treated with a valved-conduit and needed anticoagulation with warfarin if a mechanical valve was used or were left with uncertain long-term durability if a biological valve was used. There are two different types of valve-sparing operations available (reimplantation and remodeling technique). Of these two techniques, the reimplantation technique has several advantages but is also technically more demanding. Therefore this paper describes surgical details of the reimplantation technique and the potential pitfalls as well as some results.