Tirone David Operation

According to the last European Guidelines surgery is indicated in patients who have an ascending aorta diameter more than 55 mm, with lower threshold in presence of elastopathy or bicuspid aortic valve with risk factors associated. When the aortic root is also interested from the aneurismal disease, presenting loss of the sino-tubular junction, and the aortic valve isn't damaged or diseased a valve-sparing aortic root replacement is indicated.

 The aortic valve, the aortic root and the rest of the aneurismal ascending aorta can be replaced en bloc using a composite valve conduit, mechanical or biological, with coronary ostia reimplantation on the graft. The surgery is performed in Cardiopulmonary Bypass assistance, cross-clamping the Aorta, over the aneurysmal segment, with cardioplegic arrest of the heart. The surgical approach of the ascending aorta can be performed either with a  traditional full median sternotomy or, in selected cases, witha a partial upper sternotomy.