The David Procedure (also known as valve-sparing aortic root replacement) is a specialized procedure for aortic root aneurysms. 

The aortic root is special in that it contains both the aortic valve, as well as the origins of the coronary arteries. When an aneurysm is located in the root, you must treat the aneurysm and address the valve and coronary origins.

Benefits of Valve-Sparing Aortic Root Replacement (David Procedure)

  • Many heart centers perform a procedure called a Bentall operation, which replaces the root aneurysm as well as the aortic valve. This is typically done whether or not there is anything wrong with the valve.
  • In valve-sparing aortic root replacement (also called aortic valve re-implantation), the patient’s aortic valve is extensively dissected from its attachments. It is then re-implanted into the aneurysm replacement graft.
  • The David Procedure has been found to:
    • Be as durable as mechanical valves at 15 years of follow-up
    • Eliminate severely leaking aortic valves (aortic regurgitation)
    • Eliminate the need for taking life-long blood thinners that would come with a mechanical valve replacement
    • Eliminate the need for repeat valve replacement that comes with a biological valve replacement

Candidates for the David Procedure

Certain patients with root aneurysms may not be candidates for the David Procedure:

  • If the aortic valve itself is not healthy, it should not be preserved or re-implanted.
  • Calcification of the valve often means someone will not be a candidate. Note: Some imaging studies, especially echocardiograms, may suggest that a particular valve is calcified when it is not. This misinterpretation might be due to valve leaflet thickening, which is common in bicuspid aortic valves (BAVs).

Why Choose Valley for the David Procedure?

  • Expertise in valve repair and replacement: Sometimes valves are not suitable for re-implantation because of a patient’s age and overall health, or because of the valve’s anatomy. In these cases, our surgeons remove the valve and perform a traditional aortic root replacement. Our team has experience with both traditional aortic root replacement and valve-sparing aortic root replacement. This allows us to better determine which will be the best option for you.
  • Extensive experience: The Thoracic Aneurysm Program at Valley has the largest active experience with the David Procedure in our area, outside of New York City. We have performed this surgery in patients aged up to their young 70s. 
  • Cleveland Clinic alliance: Valley is an alliance member of Cleveland Clinic’s Heart, Vascular & Thoracic Institute. That means you benefit from second opinions from the No. 1 heart program in the nation (as ranked by U.S. News & World Report since 1995) without leaving home.
  • Long-term benefits: By preserving the aortic valve, you will not need to take lifelong blood thinners. You will also not need to have a repeat valve replacement in 10-15 years.