Current trends in minimally invasive valve-sparing aortic root replacement-Best available evidence.

Evidence from nonrandomized observational and comparative studies demonstrated excellent clinical outcomes of minimally invasive David procedure in selected patients with comparable perioperative mortality and outcomes to the conventional technique. To date, David procedure with a minimal access technique has been performed in carefully selected patients. We believe it could be particularly beneficial to provide younger patients (Marfan syndrome and bicuspid aortic valve) with minimally invasive David procedure as it can allow faster recovery with improved cosmesis with excellent outcomes. 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.