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OBJECTIVE: Aortic valve reconstruction following the Tirone David principle is a complex but efficient procedure for Aortic valve insufficiency with good results. Objective of this study was to retrospectively investigate the short- and long-term results of this procedure in our center.
METHODS: Data from 100 patients was retrospectively analysed. Endpoints were long term survival and reoperation rate. Continuous data is given as mean with standard deviation; linear data is given as parts.
RESULTS: Mean age of patients was 47 ± 15 years, 83% were female. 51% had aortic insufficiency (AI) grade 3 or 4 preoperatively and 22% had a bicuspide valve. 13 patients were operated as emergency because of aortic dissection Standford Typ A. 29% were diagnosed with Marfan Syndrom through histology. 43% had diagnosed hypertension, 4% had preoperative stroke and 1% had preoperative renal impairment. Mean ejection fraction preoperatively was 60 ± 10%. Main part of the patients had no symptoms 72%. 4% were in NYHA class III. The rest in class I or II.
Mean diameter of the aortic root was 5.2 cm. The operation was performed as redo procedure in 9% of cases. 10 patients had additionally a bypass operation, 5 patients an additional valve operation other than the aortic valve. In 7 patients, aortic arch surgery was performed additionally. Mean CPB time was 210 ± 86 min. Mean cross-clamp time was 148 ± 60 min.
Postoperative Echocardiography showed no AI in 24% of cases. 40% had trivial AI and 28% had mild AI. In 6% of cases Moderate AI was seen. 2 patients showed persistent severe AI resulting in immediate conversion to valve replacement. 5 further patients had a reoperation due to new AI, aortic stenosis or endocarditis between 20 month to 124 month after the initial operation. Mean follow-up time was 42 month, median follow up was 27 month (0-211 month). 5-year survival was 94.1 ± 3% (1.1 death/100 patient years).
CONCLUSIONS: Short and long term outcome of the Tirone David procedure shows good results with high survival and low reoperation rates also if performed in patients with aortic dissection and bicuspid valve.