If an aortic root in the heart develops an aneurysm or a clamping, it can be life-threatening and requires surgery to replace the diseased part of the patient’s vessel with an artificial vessel. But an important part of the artery root adjacent to the heart valve, when it is not diseased or the lesion is mild, can also be “involved for no reason” in the traditional surgery, along with the diseased vessel is replaced. In contrast, 45-year-old Mr. Peng recently underwent a treatment method called “David’s surgery” at the Cardiovascular Surgery Department of the Second Affiliated Hospital of Nanjing Medical University, where doctors not only successfully replaced the diseased aortic root with an artificial vessel, but also preserved his aortic valve, making the surgery a success. This not only meant that Mr. Peng’s life was brought back from the death line, but also allowed him to live like a normal person in the future. This surgery is also the first David surgery for “type A aortic coarctation” in the province. At present, there are only a few doctors in China who dare to apply David’s surgery in the treatment of type A aortic coarctation. “Aortic coarctation is very dangerous, especially type A aortic coarctation where the lesion occurs close to the root of the aorta, and if it is not treated in time, the mortality rate is 50% within 3 days and up to 75% within a week.” Director Li Qingguo, who performed this surgery, explained. The human heart is connected to the aorta, and the heart beats to squeeze out the blood and deliver it to the whole body through the aorta. If the endothelium of the aorta is broken, and the blood flowing through it keeps hitting it, the endothelium of the aorta’s vessel wall will gradually peel off, the wound will expand, the blood will “run the wrong way”, and a sandwich will form inside the aorta here, becoming a “false lumen”. The blood continuously fills the “false lumen” and blocks the “correct path” of blood, the true lumen. This is called “aortic coarctation”, and surgery is required to remove this lesion and replace it with an artificial vessel. They are located between the left ventricle and the aorta and consist of three leaflets that act as a “door”, opening when the heart is contracting and closing when the heart is diastolic, blocking the blood flow in the aorta from flowing back into the left heart. The valve opens during systole and closes during diastole to block regurgitation of blood from the aorta into the left ventricle. In some patients, the valve is normal or mildly diseased, but traditional surgery “uproots” the valve – replacing the aortic valve with a prosthetic valve. Patients with mechanical valves take anticoagulants for life to prevent blood clots, while patients with biological valves have a maximum life expectancy of 15 to 20 years, and many young and middle-aged patients may have to undergo a second surgery several years later. The main goal of David’s procedure is to preserve the patient’s aortic valve and replace the aortic root with an artificial vessel,” said Qingguo Li. The David procedure is generally indicated for patients with aortic root aneurysms with less severe leaflet lesions, as well as patients with type A coarctation who have mild aortic root lesions and normal aortic leaflets.” However, the main reason that currently prevents the development of Daivd surgery is that it is too risky. “The current average mortality rate for type A aortic coarctation surgery in China is about 20 percent because the procedure is so traumatic and prone to bleeding. And the David procedure itself is also prone to bleeding, so applying the David procedure to the treatment of type A aortic coarctation can be doubly risky and requires a significant level of physician proficiency to perform.” Although the David procedure is difficult and risky, it is not the first time that Qingguo Li has been the chief surgeon for this type of surgery. As early as last October, he used the David procedure at the Second Affiliated Hospital of Southern Medical University to treat a patient with Marfan syndrome aortic root aneurysm, and the procedure was very successful, with the patient’s aorta not regurgitating on review six months after the surgery. “Type A aortic coarctation is predominant in China in patients between the ages of 30 and 50, and hypertension is an important cause of its development. Currently, there are more and more patients with hypertension, however, many patients do not pay attention to taking medication, resulting in an increasing incidence of aortic coarctation and more and more patients facing the problem of whether to replace the aortic valve. david’s surgery can be considered a blessing for patients.”