What is an Aortic Root?
An aortic root is the section of the aorta (the body’s main blood vessel) that is connected to the heart.

What is an Aortic Valve?
An aortic valve lets blood flow from the left lower chamber of the heart (left ventricle) to the aorta. The aorta distributes blood throughout the body.

What is Valve-Sparing Aortic Root Replacement?
Valve-sparing aortic root replacement, also know as the David Procedure, is a surgery to repair aortic valves that aren’t working correctly. During this surgery, only the diseased part of the aortic root is replaced. The aortic valve is left intact.

When Do Aortic Valves Need to be Repaired or Replaced?
Aortic valves help pump blood out of the heart to the rest of the body. In a person with aortic valve disease, the aortic valve has a malfunction:

• Regurgitation – The aortic valve doesn’t close completely, causing blood to flow backward instead of forward through the valve.
• Stenosis – The aortic valve opening doesn’t form properly or becomes narrow, inhibiting the flow of blood out of the chambers of the heart. When this happens, the heart is forced to pump blood with increased force in order to move blood through the stiff (stenotic) valve.

Aortic valves can have regurgitation and stenosis at the same time.

When heart valves fail to open and close properly, the heart can become damaged. Heart valve problems are one cause of heart failure.

Who can Benefit from Aortic Root Replacement?
Aortic root replacement may be an option for those with a condition called bicuspid aortic valve disease, an aortic aneurysm or other conditions that result in regurgitation.

How is Valve-Sparing Aortic Root Replacement Performed?
During an open surgical procedure, the surgeon removes the damaged portion of the aorta and the aortic tissue around the aortic valve. He then slips a section of woven cloth tubing over the valve, completely encasing it like a fingertip in a glove. The tube acts like a support hose, stabilizing the valve while preventing further expansion that could lead to valve failure. The surgeon then anchors the valve by stitching it to the inside of the tube before reconnecting the coronary arteries that feed the heart muscle and the loose end of the natural aorta.

Valve-sparing aortic root repair. During valve-sparing aortic root replacement, the surgeon removes the aneurysm and the tissue surrounding the valve, including the right and left coronary arteries that supply blood to the heart (A and B). Sutures are used to attach a woven tube to the heart (C) and the valve is firmly anchored within the tube with another row of sutures (D). The coronary arteries are then reattached to the tube, and the top of the tube is connected to the loose end of the aorta (D).