Heart Surgery

Valve-Sparing Aortic Root Replacement

Valve-sparing aortic root replacement (VSARR), also called the David Procedure, is a specialized surgical procedure that repairs the aortic root while preserving the aortic valve. One of four valves in the heart, the aortic valve pumps oxygenated blood to the rest of the body.

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Who Is Eligible for Valve-Sparing Aortic Root Replacement?

Valve-sparing aortic root replacement is used to treat:

Aortic root aneurysm: This condition is caused by an abnormal bulge (aneurysm) in the aortic root. An aortic root aneurysm is a type of thoracic aortic aneurysm. If the aortic root grows too wide, it can prevent the aortic valve from fully closing or cause the aorta tearing (aortic dissection) or rupturing. An aortic root aneurysm can also interfere with normal valve function and cause the valve to leak blood backward into the heart (aortic regurgitation).
Ascending aortic aneurysm with dilated aortic sinuses: This condition occurs when a patient has an abnormal widening of the ascending aorta (ascending aortic aneurysm) and their aortic sinuses (three segments of the aortic root) are wider than normal but not wide enough to be classified as an aneurysm.

You may be a candidate for valve-sparing aortic root replacement if your aortic valve:

Has very little or no calcium build-up (calcification).
Has very little to no damage.
Works properly or can be repaired.

To help plan your surgery, your surgeon will order certain tests. These may include:

Echocardiogram (ECG)
Cardiac and chest ECG-gated computed tomography (CT) scan
Blood tests
Cardiac magnetic resonance imaging (MRI)
Coronary angiogram
Genetic blood test for suspected connective tissue disorder

Your will receive detailed instructions to prepare for your surgery, which may include:

Modifying your usual medication schedule.
Fasting after midnight the night before your surgery.
Taking certain medications on the morning of your procedure.
Arranging for someone to drive you to and from the hospital.

To perform the valve-sparing aortic root replacement, your surgeon works closely with a specially trained cardiac anesthesiologist to put you into a deep and comfortable sleep-like state. Your surgeon then:

Makes an incision in the chest and connects you to a heart-lung (cardiopulmonary) bypass machine, which allows your heart to be temporarily and safely stopped; the heart-lung machine performs the work of your heart and lungs during the procedure.
Places a clamp across the aorta and surgically removes the enlarged segment of the aorta, including the aortic valve.
Places the aortic valve inside a synthetic tube (graft) that will serve as the replacement aortic root.
Sews the valve-in-graft to the heart and attaches the upper part of the graft to the aorta.

Valve-sparing aortic root replacement surgery generally takes four to six hours.

Following surgery, most patient spend one or two days in the intensive care unit (ICU) before moving to a regular hospital room. During your stay in the hospital, your care team will monitor you closely to make sure you’re recovering well. You will be hooked up to tubes to drain fluids and receive medications to alleviate your pain and prevent blood clots.

Most patients go home in approximately four days to one week. Prior to your discharge, you’ll have a repeat echocardiogram and chest CT scan to make sure your repair is working well.

Full recovery from valve-sparing aortic root replacement typically takes six weeks. Participation in a cardiac rehabilitation program can speed your recovery and you get back on your feet again sooner.

During and following your recovery, you will meet with your surgery team for follow-up appointments. Your doctor will advise when you can return to your usual activities. Most people must wait at least six weeks before they can:

Lift heavy objects
Drive
Return to work

All major surgeries carry some risks. Though uncommon, possible complications of valve-sparing aortic root replacement include:

Bleeding
Blood clots
Breathing problems
Heart attack or stroke
Infection in the graft
Infection in your lungs, urinary tract or abdomen
Kidney failure
The need for a pacemaker

Age, medical conditions and other factors affect the risk of complications. Your surgeon will discuss your risk factors and what can be done to optimize the success of your surgery.

Why Choose University Hospitals for VSARR?

Unparalleled clinical expertise

Highest quality patient outcomes

Office visits and imaging coordinated on the same day

Quick, convenient access with sites across the region

Virtual appointment option for follow up care

Who Performs Valve-Sparing Aortic Root Replacement at University Hospitals?

University Hospitals Harrington Heart & Vascular Institute’s heart surgery program, based at University Hospitals Cleveland Medical Center, in Cleveland, Ohio, is consistently ranked in the top 1 percent of hospitals nationwide.

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Make an Appointment

For more information, or to schedule an appointment with one of our heart surgeons, call 216-541-1187.

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