Beyond Traditional Valve Replacement: The Advantages of the David and Yacoub Procedures
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Beyond Traditional Valve Replacement: The Advantages of the David and Yacoub Procedures
Prof Dato’ Seri Dr Azhari Yakub, Senior Consultant Cardiothoracic Surgeon
For decades, patients diagnosed with aortic root aneurysms or aortic valve diseases often faced a difficult choice: undergo valve replacement surgery and live with a lifelong dependency on blood thinners, or risk worsening heart complications. However, advancements in cardiovascular surgery now offer a better alternative – Valve-Sparing Root Replacement( VSRR), a life-changing procedure that preserves the patient’ s natural aortic valve while repairing the damaged aortic root.
The two main techniques used in VSRR are the David Procedure and the Yacoub Procedure. Both are intricate forms of surgery designed to address conditions such as Marfan syndrome, bicuspid aortic valve disease, and aortic root aneurysms, which can lead to life-threatening complications if left untreated. According to a Cardiothoracic Surgeon at Institut Jantung Negara( IJN), these conditions are becoming increasingly prevalent in Malaysia.
“ Aortic root aneurysm is a silent threat,” said Prof. Dato’ Seri Dr Mohd Azhari Yakub, Senior Consultant Cardiothoracic Surgeon.“ Most patients do not experience symptoms until the aneurysm reaches a critical size or ruptures, which can be fatal. Some might notice chest pain, shortness of breath, or a pulsating sensation in the abdomen, but by then, the risk of dissection is already high.”
The David Procedure, also known as the reimplantation technique, involves removing the dilated aortic root while preserving the patient’ s native valve. The valve is then reimplanted into a synthetic graft, ensuring both structural integrity and functionality. On the other hand, the Yacoub Procedure, or remodeling technique, reshapes the aortic root while retaining the valve, but it lacks the long-term stability of the David Procedure in certain cases.
Statistics show that heart disease remains the leading cause of death in Malaysia, with the National Heart Registry reporting an increasing number of aorticrelated conditions among younger patients.“ We are seeing more cases of aortic root aneurysms in patients in their 30s and 40s, many of whom are unaware of their condition until an incidental finding during routine checkups,” Dr. Azhari explained.
Despite the complexity of VSRR, it offers significant benefits over traditional valve replacement.“ Patients who undergo this surgery avoid lifelong anticoagulation therapy, which is required for mechanical valve replacements. This is especially crucial for younger patients who want to maintain an active lifestyle without the risks associated with blood thinners,” he added.
While VSRR is widely practiced in leading cardiac centers worldwide, IJN remains the only center in Malaysia that offers this highly specialized procedure. With its team of dedicated cardiac surgeons and advanced facilities, the institution continues to set the benchmark for complex cardiovascular interventions in the country.
For those diagnosed with aortic root aneurysms or related conditions, early intervention is key. Patients experiencing symptoms or with a family history of aortic disease are encouraged to seek a consultation at IJN. To learn more about Valve-Sparing Root Replacement or to book an appointment, call the IJN Call Centre at 03-2617 8844, email heart @ ijn. com. my, or visit www. ijn. com. my.
Prof Dato’ Seri Dr Azhari Yakub Senior Consultant Cardiothoracic Surgeon
“ Patients who undergo this surgery avoid lifelong anticoagulation therapy, which is required for mechanical valve replacements. This is especially crucial for younger patients who want to maintain an active lifestyle without the risks associated with blood thinners.”
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