Several non-randomized observational and comparative studies
demonstrated excellent clinical outcomes of minimally invasive David
procedure in selected patients with comparable perioperative mortality
to the conventional technique. To date, elective David procedure with a
minimal access technique has been performed in low- and
intermediate-risk patients. We believe that minimally invasive David
procedure could be particularly useful in young patients (Marfan
syndrome, bicuspid AV) as it allows faster recovery with improved
cosmesis. A decision to perform minimally invasive David procedure
should be individualized to each patient and based on the experience of
the team. Further large prospective randomized studies with long-term
follow-up are still needed to confirm durability of minimal access
technique and to investigate whether this approach can be useful for
other subgroups of patients (high-risk, need for aortic valve repair).
Ethical approval: Not directly applicable since this is a
review paper. The authors confirm that written consent for submission
and publication of patient’s intraoperative image has been obtained from
the patient in line with COPE guidance.
Author contributions: Davorin Sef: conceptualization, formal
analysis, investigation, methodology, validation, resources, writing –
original draft, critical revision and approval of the article. Toufan
Bahrami, Shahzad G. Raja, Tomislav Klokocovnik: conceptualization,
formal analysis, validation, resources, supervision, writing –
reviewing and editing.