General Thoracic and Cardiovascular Surgery

, Volume 67, Issue 1, pp 66–69 | Cite as

Tirone on Tirone David operation and types

  • Tirone E. DavidEmail author
SPECIAL EDITION Controversies in Surgery for Thoracic Aorta

Historical perspective

Innovative surgical procedures often arise from foundations of knowledge and experiences with established operations. Aortic valve sparing operation was one of this stepwise, evolutionary procedure. Because there is no perfect heart valve substitute I have always tried to repair rather than replace heart valves whenever feasible. The most common lesion in aortic valve disease in adult patients, aortic stenosis, is not suitable for repair, and replacement is necessary, and for several decades the choices have been mechanical or tissue valves. I had been using aortic valve homograft for aortic valve replacement right from the beginning of my practice but procurement and supply was a limiting factor to expand its use. This was the impetus to develop stentless porcine aortic valves [1, 2]. Implantation of biological valves (aortic homograft, pulmonary autograft or stentless porcine aortic valves) in the sub-coronary position requires a sound knowledge of functional...


Aortic valve Aortic valve insufficiency Aortic root aneurysm David operation 


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Copyright information

© The Japanese Association for Thoracic Surgery 2017

Authors and Affiliations

  1. 1.Division of Cardiovascular Surgery, Peter Munk Cardiac CentreToronto General HospitalTorontoCanada
  2. 2.University of TorontoTorontoCanada

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