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Valve Sparing Aortic Root

Valve Sparing Root (aka David Procedure)

When the aorta is dilated, but the aortic valve is structurally otherwise normal, the aorta can be replaced (“root replacement”) while preserving the aortic valve (“valve sparing”). This avoids the need for a valve replacement with an artificial valve.  Thus offering the possibility for a more durable repair, as well as avoiding the potential need for blood thinning medication.

This approach also known as the David Procedure is a significant advance in aortic surgery. It is a highly advanced technique that requires special expertise and equipment. It should only be performed by experienced centers on well-selected patients.

  • Prior to the procedure, our surgical team, along with our cardiovascular imaging experts, carefully assess the valve and aorta to determine if the patient is a candidate for this specialized procedure.
  • In the operating room, the patient is temporarily supported by cardiopulmonary bypass (aka a heart-lung machine), which takes over the function of the heart and lungs.  This is standard for heart and aortic surgery.  
  • After sowing a graft to the axillary artery, the bloodflow is temporary stopped to the heart and the beginning portion of the aorta (aka the aortic root) to allow for the surgery to be performed. In addition, at our center, a special technique of circulating blood to the brain known as antegrade cerebral perfusion (ACP) is used to ensure the brain is protected during crucial portion of the operation
  • Next the diseased aortic tissue is removed
  • Leaving behind only the origins of the coronary arteries  and aortic value leaflets. 
  • The aortic valve is then remodeled within the graft to eliminate leaking. This requires meticulous attention to ensure that the valve, based on its unique height and width, fits perfectly within the graft and any structural abnormalities of the valve are repaired. This ensures that the valve function properly, and the repair is durable. 
  • Then two small holes are created in the graft for reattachment of the coronary arteries–left and right.
  • Finally, the opposite end of the graft is attached to the aortic arch.
To schedule an in-person or telemedicine consult-ation with Dr. Russo, call 732-235-7231 or send an email
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Dr. Russo is Professor of Surgery, Chief of Cardiac Surgery, and Director of Structural Heart Disease at Rutgers-Robert Wood Johnson Medical School

Dr. Russo is an internationally-known expert in the treatment of heart valve disease He specializes in complex and reoperative aortic and valvular surgery.

Dr. Russo is one the few heart doctors in the U.S. skilled at open, minimally-invasive, and catheter-based cardiac therapies. He is one of the most experienced transcatheter valve surgeons (including TAVR and Mitraclip) in the U.S. and has participated in more than 500 successful organ transplants.

His experience and uniquely broad skillset provides singular insights into specialized treatments for heart disease, particularly for complex and/or high risk patients.  This includes patients who have been told that there is no therapy that can provide them benefit.

Dr. Russo has coauthored more than 200 published manuscripts, abstracts, and textbook chapters focused on improving health care quality, outcomes, and access for patients with cardiovascular disease. Dr. Russo holds leadership roles for numerous national and international clinical trials. The findings of his work have been published in the New England Journal of Medicine (NEJM), the Lancet, the Journals of the American Medical Association (JAMA), and Circulation and reported by major media outlets, including the New York Times, Washington Post, ABC News, U.S. News & World Report, and Newsweek.

Clinical Trials at RWJUH

Transcatheter aortic valve replacement vs OMM (randomized) for asymptomatic severe AS The EARLY TAVR trial (Edwards) looks at transcatheter aortic valve replacement (TAVR) as an effective treatment for patients with asymptomatic aortic stenosis. Patients are randomized to either treatment with TAVR or clinical surveillance until the develop symptoms, at which point they are eligible to be treated with TAVR.  Read More

This study objective is to establish the safety and effectiveness of the Edwards SAPIEN 3/ SAPIEN 3 Ultra Transcatheter Heart Valve in subjects with moderate, calcific aortic stenosis. Patients are randomized to S3 TAVR device or medical management.  Read More

ALIGN-AR evaluates the safety and probable benefit of the transfemoral JenaValve Pericardial TAVR System in patients with symptomatic severe aortic regurgitation. Patients who are high risk for open surgical aortic valve replacement/repair are eligible. RWJUH is one of only 15 centers in the U.S. that can offer this therapy that has been granted a “Breakthrough Device Designation” by the US Food and Drug Administration. This designation is reserved for investigative therapies designed to treat a serious or life-threatening disease or condition and where preliminary clinical evidence indicates that the therapy may demonstrate substantial improvement over existing therapies on one or more clinically significant endpoints, such as substantial treatment effects observed early in clinical development.

Transcatheter aortic valve replacement for severe AS with a novel deviceEvaluates the safety and efficacy of Acurate (Boston Scientific) valve for transcatheter aortic valve replacement. For patients with severe aortic stenosis who are at intermediate or greater risk for SAVR. Patients are randomized to Acurate or commerical TAVR device. Read More

The study is a prospective, multi-center, randomized controlled pivotal clinical trial to evaluate the safety and effectiveness of the EVOQUE System with optimal medical therapy (OMT) compared to OMT alone in the treatment of patients with at least severe tricuspid regurgitation. Subjects will be followed at discharge, 30 days, 3 months, 6 months and annually through 5 years.

This study will establish the safety and effectiveness of the SAPIEN M3 System in subjects with symptomatic, at least 3+ mitral regurgitation (MR) for whom commercially available surgical or transcatheter treatment options are deemed unsuitable.

The SUMMIT-Tendyne trial (Abbott) evaluates the safety and effectiveness of using the Tendyne Mitral Valve System for the treatment of symptomatic mitral regurgitation or mitral annular calcification in patients who are not appropriate for conventional mitral valve surgery. In the randomized arm, patients are treated with either the Tendyne device or MitraClip, while patients in the non-randomized and MAC arms receive the Tendyne device. https://clinicaltrials.gov/ct2/show/NCT03433274

CLASP IID/F is a prospective, multicenter, randomized, controlled pivotal trial to evaluate the safety and effectiveness of transcatheter mitral valve repair in patients with degenerative/functional mitral regurgitation with the Edwards PASCAL Transcatheter Valve Repair System compared with the commercially available device (Abbott MitraClip).

RESTORE is a prospective, multicenter, non-randomized trial designed to evaluate the safety and effectiveness of the HARPOON™ Beating Heart Mitral Valve Repair System in patients with severe degenerative mitral regurgitation (DMR).

Commonly Performed Procedures

Minimally invasive valve surgery is a specialized approach to treating heart valve disease that avoids the need to “crack the chest.” This method uses sophisticated instruments to perform the surgery through a smaller incision at the side of the chest and offers the patients less pain and faster recovery. We perform nearly all of our isolated valve surgeries minimally invasively.


An aortic aneurysm is a bulging, weakened area in the wall of main blood vessel in the body. The risk of aortic catastrophe, including dissection and rupture, increases dramatically with an aneurysm. Surgery may be recommended when the aorta is larger than 4.5-6 cms. Factors including family history, lifestyle, and need for other heart surgery guide decisions about surgery.​

Transcatheter aortic valve replacement (TAVR), also known as transcatheter aortic valve implantation (TAVI), is a minimally invasive approach to the treatment of aortic stenosis. In most patients, it requires no incision and typically patients are discharged within 1 day. Dr Russo is among the most experienced TAVR surgeons in the US.

A “bypass” or “cabg” surgery is the most commonly performed heart surgery. It is necessary when the coronary arteries, which provide blood to the heart become narrow preventing sufficient blood from passing through, and thus depriving the heart of oxygen and nutrients. RWJUH has CABG outcomes that exceed national benchmarks.

When other treatments are insufficient, a heart transplant is a surgical procedure offered to patients with the most severe damage to the heart. RWJUH is one of a limited number of centers in the US that offer advance heart failure surgery, including heart transplant. Dr. Russo has participated in 500+ successful transplant surgeries.

The MitraClip device is a small clip that helps your mitral valve to close more completely. The procedure does not require opening the chest or stopping the heart. Instead, through a vein in the leg, a thin tube (called a catheter) is guided to the mitral valve. Dr. Russo is among the highest volume Mitraclip operators in the Northeast.​​

To schedule an in-person or telemedicine consultation with Dr. Russo,
please call 732-235-7231 or send an email