This case demonstrates the feasibility of combining valve-sparing root replacement (David technique) with zone 2 arch reconstruction in the acute setting of Stanford type A dissection with malperfusion, allowing restoration of true lumen flow while preserving native valve function.
Key Findings
Methods
A 52-year-old man with acute Stanford type A aortic dissection extending from the aortic root to the iliac bifurcation with arch involvement was successfully treated with emergent valve-sparing root replacement.
The dissection was complicated by severe aortic insufficiency and right lower extremity malperfusion.
The procedure used the David technique (David-V) combined with zone 2 arch reconstruction.
Surgery was performed under hypothermic circulatory arrest and selective antegrade cerebral perfusion.
This is a single case report (n=1).
Results
Intraoperative echocardiography confirmed excellent valve function following the David-V valve-sparing root replacement.
Residual aortic regurgitation was trace on intraoperative echocardiography.
The preoperative presentation included severe aortic insufficiency, which was resolved by the procedure.
Native valve was preserved rather than replaced.
Results
The postoperative course included transient vasoplegia and re-exploration without identified bleeding source, followed by uneventful recovery.
The patient was discharged on postoperative day 11.
Re-exploration was performed but revealed no active bleeding source.
Transient vasoplegia was noted as a complication.
Recovery following these complications was described as uneventful.
Conclusions
The case highlights that combining valve-sparing root replacement with zone 2 arch reconstruction is feasible in the acute setting of Stanford type A dissection complicated by malperfusion.
Valve-sparing aortic root replacement is described as 'increasingly used in selected patients with acute aortic dissection and preserved valve anatomy.'
Zone 2 arch reconstruction allowed restoration of true lumen flow.
The combination of procedures addressed both the root pathology with severe aortic insufficiency and arch involvement simultaneously.
The authors note this approach allows preservation of native valve function while managing complex dissection anatomy.
What This Means
This research presents a single patient case study of a 52-year-old man who had a severe tear in his aorta (the body's main artery) that stretched from near his heart all the way down to his pelvis. The tear caused the aortic valve to leak severely and cut off blood flow to his right leg. Surgeons performed emergency surgery using a specialized technique called the David-V procedure, which repairs the aortic root while saving the patient's own natural heart valve, combined with reconstruction of the aortic arch — the curved portion of the aorta near the heart.
The surgery was successful in restoring normal blood flow through the true channel of the aorta and correcting the severe valve leakage, leaving only a trace amount of regurgitation detectable on ultrasound during the operation. After surgery, the patient experienced some temporary low blood pressure requiring treatment and needed a return to the operating room to check for bleeding, but ultimately recovered well and went home 11 days after surgery.
This research suggests that in carefully selected patients, it may be possible to save the native aortic valve rather than replacing it — even in emergency situations involving complex aortic dissections with multiple complications. Traditionally, valve replacement during emergency aortic surgery has been more common, but this case adds to growing evidence that valve-preserving approaches can be performed safely in acute settings, potentially offering patients long-term benefits of keeping their own valve.
Gecse I, Lopez Trevino M, Székely M, Cambiaghi T, Sarfaraz Z, He Y. (2026). David-V Procedure Combined with Zone 2 Arch Replacement for Acute Stanford Type A Dissection.. Methodist DeBakey cardiovascular journal. https://doi.org/10.14797/mdcvj.1902