Fifteen-year experience with the Tirone David procedure in bicuspid
aortic valve: a safe option.
Background We evaluated short- and mid-term outcomes with use of aortic
valve-sparing root replacement to treat bicuspid aortic valves. Methods
From December 2007 to January 2022, all patients with bicuspid aortic
valves who underwent aortic root replacement using Tirone’s procedure
were included. This study based on department database information for
retrospective and follow-up data. Results Among 51 adults undergoing
aortic root replacement using Tirone’s procedure, the mean age was
47.4±12.5 years, and most were men (92.2%). Three presented with a
dysmorphic syndrome and one had Marfan’s syndrome. All patients were
alive at 30 days, and as of January 2022, 45 were alive, two were lost
to follow-up, and there were four noncardiac deaths. Two patients had
infectious endocarditis and needed a Bentall’s procedure. One patient
had a double biologic valve replacement in the context of severe mitral
insufficiency with moderate aortic stenosis at 4.5 years post-procedure.
Echocardiographic follow-up showed a left ventricular ejection fraction
of 63±7% (n=36), V max 2±0.6 m/s (n=17), and a mean
gradient of 9.4±5.4 mmHg (n=27). No patients had grade 3 or 4 aortic
regurgitation, one patient had grade 2, and four had grade 1. Conclusion
Tirone’s procedure is an option for bicuspid aortic valve surgery, with
good safety and outcomes, especially in younger patients.