A Short-Term Experience with the Tirone David I Valve Sparing Operation for the Treatment of Aneurysms of the Ascending Aorta and Aortic Root

Abstract

Aim

The aim of this report is to summarize our experience with the Tirone David I technique over a 4-year period.

Methods

Since 1997 15 patients were operated on using this surgical procedure. Of the patients, nine were male (60%) and six (40%) female. Ages ranged from 23 to 75 years (mean 62.1 ± 17.2 years). The underlying disease was chronic aneurysm of the ascending aorta or root in 13 (86.6%) and chronic dissection in two (13.4%). Four patients (26.6%) had skeletal manifestations of Marfan's syndrome. Additional cardiac procedures were performed in two patients (13.4%). Mean follow-up time was 26.6 ± 11.2 months (range 7–50 months).

Results

There were no early deaths. Postoperative non-fatal complications occurred in two (13.3%) patients. There was no valve-related late death occurring 6 months after operation. Actuarial survival was 0.94 ± 0.07 at 4 years; 4-year freedom from reoperation was 0.91 ± 0.07. The probability of needing reoperation was 8 ± 0.9%. There were no instances of infective endocarditis or thromboembolic complications. At the end of the follow-up period, trivial or no aortic regurgitation was demonstrated in 57.1%, mild in 42.9% and no patient had an insufficiency graded ≥moderate. Echocardiography showed early postoperative reduction in left ventricular end-systolic and end-diastolic dimensions, which was maintained at follow-up controls.

Conclusions

The Tirone David I procedure showed good early results, which encourage further use of this type of repair. However, further larger studies and long-term results are necessary for a definite judgment on this operative method.

Keywords

Ascending aortic aneurysm Aortic valve surgery Aortic valve repair

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