Early- and longer-term outcomes of David versus Florida sleeve procedure: propensity-matched comparison
Abstrakt
Abstract OBJECTIVES: The aim of this study was to compare short- and longer-term outcomes of David (DV) versus Florida sleeve (FS) procedure in patients requiring valve-sparing aortic root replacement. METHODS: Between January 1996 and December 2020 285 patients received a DV procedure (median age 60 years; 26% females) and 57 patients underwent an FS procedure (median age 64 years; 19% females) in our department.
Propensity score matching using patient characteristics led to 58 (DV) versus 57 (FS) patients. End points were defined as primary: freedom from aortic valve and/or aortic root-related reoperation and freedom from aortic regurgitation >_moderate and secondary: early and late survival.
RESULTS: Thirty-day mortality was 2% (DV) and 0% (FS) (P = 0.319). There was 1 early stroke in each group (P = 0.990).
Follow-up was complete in 99% with only 1 patient (FS) lost. The 5- and 10-year freedom from aortic valve and/or aortic root related reoperation was 98 +- 2% and 96 +- 3% in the DV group and 92 +- 5% and 84 +- 9% in the FS group, respectively (P = 0.095).
The 5- and 10-year freedom from aortic regurgitation >_moderate was 88 +- 5% and 80 +- 8% in the DV group and 92 +- 5% and 78 +- 1% in the FS group, respectively (P = 0.782). The 5- and 10-year survival rates were 93 +- 4% and 82 +- 6% (DV) vs 75 +- 7% and 67 +- 10% (FS), respectively (P = 0.058).
No case of endocarditis (DV) and 3 cases of endocarditis (FS) (P = 0.055) were observed during follow-up. CONCLUSIONS: Both DV and FS resulted in similar early and longer-term outcomes with a trend to slightly better performance and survival in the DV group.
Florida sleeve procedure might be an alternative approach for patients with higher-risk profiles requiring valvesparing aortic root replacement.