Pre- and intra-operative risk factors for re-operation after valve sparing aortic root replacement using the David technique. Results from two European centers

Background This study investigates pre- and intra-operative risk factors for re-operation after valve sparing aortic root replacement using the David technique to develop a risk model. Methods A retrospective cohort study of two European centers, comprising data from 07/1993 to 01/2025 was performed. Follow up time was 120 (IQR: 141) months. Primary outcome was aortic valve re-operation. Prediction model was developed using uni- and multivariable logistic regression analysis. A risk score was derived. Calibration in the large and slope were performed. Receiver operating characteristic (ROC) analysis allowed discrimination assessment. Results 1,074 patients were included. Male sex (OR: 1.98; 95% CI: 1.16–3.39, p = 0.012), age at operation (OR: 0.98; 95% CI: 0.97–0.996; p = 0.011), pre-operative AI grade (OR: 1.61; 95% CI: 1.21–2.14; p = 0.001), NYHA (OR: 1.29; 95% CI: 1.0043–1.67; p = 0.046), bicuspid aortic valve (OR: 2.03, 95% CI: 1.18–3.49; p = 0.011) and prosthesis size (OR: 0.76; 95% CI: 0.66–0.86; p < 0.001) remained independent predictors in multivariable analysis. The risk model showed moderate discrimination [AUC: 0.722 (95% CI: 0.677–0.766)] and good calibration in the original cohort [intercept: −0.00 (95% CI: −0.49–0.49); slope: 1.00 (95% CI: 0.75–1.26)]. Conclusion Bicuspid aortic valve, higher pre-operative AI, NYHA grade and male sex were independent risk factors for re-operation. Higher age and larger prosthesis sizes were protective factors. Further multi-center research is needed to validate and refine the prediction model.