David vs supracoronary with non-coronary sinus replacement in acute type A aortic dissection: 5-year outcomes

BackgroundAcute 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.MethodsThis 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.ResultsThere 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).ConclusionsIn 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.