Background We evaluated short- and mid-term outcomes with use of aortic valve-sparing root replacement to treat bicuspid aortic valves. Methods From December 2007 to January 2022, all patients with bicuspid aortic valves who underwent aortic root replacement using Tirone’s procedure were included. This study based on department database information for retrospective and follow-up data. Results Among 51 adults undergoing aortic root replacement using Tirone’s procedure, the mean age was 47.4±12.5 years, and most were men (92.2%). Three presented with a dysmorphic syndrome and one had Marfan’s syndrome. All patients were alive at 30 days, and as of January 2022, 45 were alive, two were lost to follow-up, and there were four noncardiac deaths. Two patients had infectious endocarditis and needed a Bentall’s procedure. One patient had a double biologic valve replacement in the context of severe mitral insufficiency with moderate aortic stenosis at 4.5 years post-procedure. Echocardiographic follow-up showed a left ventricular ejection fraction of 63±7% (n=36), V max 2±0.6 m/s (n=17), and a mean gradient of 9.4±5.4 mmHg (n=27). No patients had grade 3 or 4 aortic regurgitation, one patient had grade 2, and four had grade 1. Conclusion Tirone’s procedure is an option for bicuspid aortic valve surgery, with good safety and outcomes, especially in younger patients.

Coronary dissection is an extremely rare but known complication of coronary catheterization and angioplasty. Due to its rarity, there are no management recommendations. However, surgery immediately after an endovascular procedure is frequently carried out under major antithrombotic treatment. The surgery and the postoperative consequences are therefore very complex. We report here the documented case of a type A aortic dissection after coronary catheterization. Despite extension to the entire ascending aorta which indicated surgical management, the benefit-risk balance argued for armed surveillance to avoid surgery under antiplatelets drugs without known antidote. We believe this case should lead us to systematically weigh the data before considering that any iatrogenic dissection of Dunning class 3 should be operated.