Key result
Tirone David procedure linked to ~60-point lower 5-year aortic regurgitation rates vs supracoronary replacement.
Why the study?
Acute aortic dissection complicated by severe AR requires urgent surgery, but the optimal root management strategy remains controversial. This study compared the long-term outcomes of the Tirone David procedure and supracoronary aortic replacement with non-coronary sinus replacement in acute type A dissection.
Does the Tirone David valve-sparing procedure improve long-term aortic valve competence compared to supracoronary replacement with non-coronary sinus replacement in patients with acute type A aortic dissection and severe aortic regurgitation?
Cohort (n=80)
Does the Tirone David valve-sparing procedure improve long-term aortic valve competence compared to supracoronary replacement with non-coronary sinus replacement in patients with acute type A aortic dissection and severe aortic regurgitation?
In relatively stable patients with acute type A aortic dissection and severe aortic regurgitation, the Tirone David procedure provides superior 5-year aortic valve competence compared to supracoronary replacement with non-coronary sinus repair without increasing perioperative mortality or complications.
Answers are grounded in this paper and cite their sources.
May support Tirone David for aortic competence in acute type A dissection; leaves open randomized confirmation before practice change.
Background Acute aortic dissection complicated by severe aortic regurgitation (AR) requires urgent surgical intervention. The optimal root management strategy remains controversial. This study compared the long-term outcomes of the Tirone David procedure and supracoronary aortic replacement with non-coronary sinus replacement in patients with acute type A dissection. Methods This retrospective observational study included 80 consecutive patients with acute aortic dissection type A (AADA) and severe AR who underwent surgery between October 2015 and February 2020 at the University Hospitals, with a 5-year follow-up. Patients were divided into two groups: valve-sparing reimplantation (Tirone David, n=40) and supracoronary repair with non-coronary sinus replacement (n=40). Outcomes included operative data, postoperative complications, mortality, and echocardiographic assessment of AR immediately postoperatively, at 6 months, and at 5 years. Results There were no significant differences in age, cross-clamp time, bypass time, intensive care stay, hospital stay, or early mortality between groups (p>0.05). Immediate postoperative AR occurred significantly more frequently in the supracoronary group (57.5% mild AR) compared with the Tirone David group (5.0% mild AR; p<0.001). At 6 months and 5 years, the incidence of AR remained significantly lower in the Tirone David group (10% and 15%) versus the supracoronary group (65% and 75%, respectively; p<0.001). Conclusions In this selected cohort of relatively stable patients with AADA and severe AR, the Tirone David procedure was associated with better long-term aortic valve competence than supracoronary aortic replacement with non-coronary sinus replacement, without an observed increase in major perioperative complications.
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Dawoud et al. (2026) conducted a cohort in Acute type A aortic dissection complicated by severe aortic regurgitation (n=80). Valve-sparing reimplantation (Tirone David procedure) vs. Supracoronary aortic replacement with non-coronary sinus replacement was evaluated on Aortic regurgitation incidence at 5 years (p=<0.001). The Tirone David procedure resulted in significantly lower 5-year aortic regurgitation rates compared with supracoronary replacement with non-coronary sinus repair (15% vs 75%; p<0.001).
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