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David procedure in 100 consecutive patients.
Session:
Sessão de Posters 04 - Prognóstico e desfechos clínicos na estenose aórtica
Speaker:
Maria Resende
Congress:
CPC 2026
Topic:
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Session Type:
Posters Eletrónicos
FP Number:
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Authors:
Márcio Madeira; Inês Alves; Maria Resende; Paulo Oliveira; José Pedro Neves; Marta Marques; Miguel Abcassis
Abstract
<p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Background:</strong><br /> The David procedure is associated with excellent long-term durability in high-volume centres, but outcomes rely heavily on technical expertise. Structured training and mentorship programmes play a key role in safely disseminating this complex operation. This study evaluates the safety and efficacy of the David procedure in a low-volume centre and underscores the importance of dedicated educational pathways.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong><br /> Single-centre retrospective analysis of 100 consecutive patients (2007–2025). Mean age was 48.9±18.2 years; 14% were female and 10% paediatric. Bicuspid aortic valve (BAV) was present in 27%. Concomitant procedures were performed in 22%, including mitral repair (8%), tricuspid repair (4%), CABG (3%) and aortic arch surgery (3%). Valve repair with leaflet plication accompanied the procedure in 53%. Follow-up was complete (100%) with a mean duration of 6.2±5.2 years. Primary endpoints were overall mortality and aortic valve reintervention. Statistical analyses included multivariate logistic regression, Cox regression and log-rank tests.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong><br /> Mean cardiopulmonary bypass and cross-clamp times were 159.9±26.8 and 132.9±19.9 minutes, respectively. Early complications were low: stroke 2%, re-exploration for bleeding 2%, mediastinitis 1%. In-hospital mortality was 2%. Kaplan–Meier analysis showed excellent long-term survival (Figure 1), with no significant difference between BAV and non-BAV patients (p=0.155). Freedom from reintervention was significantly lower in BAV patients, confirmed as an independent predictor of reoperation (HR 17.7 CI95% 2,1-147,3; p=0.002).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusions:</strong><br /> The David procedure is safe and effective even in a low-volume centre when performed by a trained and consistent surgical team. Although BAV anatomy increases the likelihood of reoperation, it does not affect long-term survival. Structured educational programmes and mentorship—such as dedicated aortic root and valve repair fellowships—are crucial to ensure high-quality, reproducible outcomes during the dissemination of this technically demanding procedure.</span></span></p>
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