Replacement of the Root and Ascending Aorta with Reimplantation of the Aortic Valve on a Beating Heart Using Antegrade Selective Coronary Perfusion of the Myocardium

Aim: to present the experience of performing David's procedure in conditions of a beating heart and parallel cardiopulmonary bypass.

Materials and methods: 59 y.o. man was admitted to the clinic for further examination for ascending aortic ectasia. According to the results of the echocardiography (EchoCG): ascending aorta – 46 mm, aortic root – 50 mm, arch – 35 mm, ejection fraction (EF) LV– 56%,  end diastolic volume  LV(EDV) – 130 ml, end systolic volume LV(ESV) – 56 ml, aortic regurgitation – 3 degrees. MSCT of the aorta: the fibrous ring of the aortic valve is 30.1 mm, the diameter of the aorta at the level of the sinuses of Valsalva is 48.3×54.4 mm, the ST zone is 38.5 mm, the ascending aorta at the level of the trunk of the pulmonary artery is 36.3 mm, the arch of the aorta in front of the brachiocephalic artery is 34.2 mm.

Results: the patient underwent valve-preserving prosthetics of the root and ascending aorta with reimplantation of the aortic valve on a functioning heart. The total time of the operation was 410 min, the CPB time was 177 min, and the time of clamping on the aorta was 150 minutes without myocardial ischemia. The postoperative period was uneventful. The patient was extubated on the day of surgery, the total ventilation time was 10 hours, he was transferred from the intensive care unit on the second day, drains were removed on the third day and the patient became active. EchoCG after surgery: ESV LV – 36 ml, EDV LV – 82 ml, EF LV – 54%, aortic regurgitation - 0. The patient was discharged in stable condition with improved well-being.

Conclusion: in this clinical case, for the first time in our clinic, an intervention on the aortic valve, aorta and coronary arteries (David's operation) was performed in a beating heart. David's successful experience of surgery on a beating heart has shown that the technique is not only applicable, but also effective.

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