title: [Replacement of the ascending aorta with conservation of the aortic valve. Results of 50 cases using the Tirone David procedure].
abstract: Aortic valve sparing operations are now widely accepted for ascending aortic aneurysm surgery. We herein report our experience of the Tirone David procedure in larger indications. From January 1997 to August 2003, 50 Tirone David procedure have been performed on 36 male and 14 female (mean age: 60 +/- 15). Five patients presented a Marfan disease and 4 acute dissections. Grade III or IV aortic insufficiency was frequent (40%). Aortic diameter was not particularly dilated, ranging from 44 to 78 mm (mean: 57 +/- 10 mm). Mean ejection fraction: 57 +/- 10%. Mean left ventricular end diastolic diameter =63 +/- 7 mm. An associated mitral valve repair and 1 coronary bypass were necessary. Mean cross clamp and bypass times =94 min and 122 +/- 28 min respectively. There was one in-hospital mortality. Secondary mortality affected 2 patients (non-cardiac deaths), for a cumulative follow-up of 946 months. During follow-up continence control was always excellent, only 1 bicuspid valve had an aortic insufficiency >grade II. Tirone David procedure gave satisfactory results as regards both aortic ectasia and aortic regurgitation control. We consider it feasible even in case of aortic dissection but caution is required when facing bicuspid aortic valves.
authors.affiliation: Hôpital cardiothoracique Louis Pradel, Lyon-Bron, France. jf.o@chu-lyon.fr
authors.forename: J F
authors.initials: JF
authors.lastname: Obadia
authors.forename: Y
authors.initials: Y
authors.lastname: Abdullatif
authors.forename: R
authors.initials: R
authors.lastname: Henaine
authors.forename: N
authors.initials: N
authors.lastname: Chavanis
authors.forename: C
authors.initials: C
authors.lastname: Saroul
authors.forename: M
authors.initials: M
authors.lastname: Barthelet
authors.forename: X
authors.initials: X
authors.lastname: André-Fouët
authors.forename: O
authors.initials: O
authors.lastname: Raisky
authors.forename: J
authors.initials: J
authors.lastname: Robin
authors.forename: J
authors.initials: J
authors.lastname: Ninet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome