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J Am Coll Cardiol. 2015 Sep 29;66(13):1445-53. doi: 10.1016/j.jacc.2015.07.041.

Outcomes of Aortic Valve-Sparing Operations in Marfan Syndrome.

Author information

1
Divisions of Cardiovascular Surgery and Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: tirone.david@uhn.ca.
2
Divisions of Cardiovascular Surgery and Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.

Abstract

BACKGROUND:

In many cardiac units, aortic valve-sparing operations have become the preferred surgical procedure to treat aortic root aneurysm in patients with Marfan syndrome, based on relatively short-term outcomes.

OBJECTIVES:

This study examined the long-term outcomes of aortic valve-sparing operations in patients with Marfan syndrome.

METHODS:

All patients with Marfan syndrome operated on for aortic root aneurysm from 1988 through 2012 were followed prospectively for a median of 10 years. Follow-up was 100% complete. Time-to-event analyses were calculated using the Kaplan-Meier method with log-rank test for comparisons.

RESULTS:

A total of 146 patients with Marfan syndrome had aortic valve-sparing operations. Reimplantation of the aortic valve was performed in 121 and remodeling of the aortic root was performed in 25 patients. Mean age was 35.7 ± 11.4 years and two-thirds were men. Nine patients had acute, 2 had chronic type A, and 3 had chronic type B aortic dissections before surgery. There were 1 operative and 6 late deaths, 5 caused by complications of dissections. Mortality rate at 15 years was 6.8 ± 2.9%, higher than the general population matched for age and sex. Five patients required reoperation on the aortic valve: 2 for endocarditis and 3 for aortic insufficiency. Three patients developed severe, 4 moderate, and 3 mild-to-moderate aortic insufficiency. Rate of aortic insufficiency at 15 years was 7.9 ± 3.3%, lower after reimplantation than remodeling. Nine patients developed new distal aortic dissections during follow-up. Rate of dissection at 15 years was 16.5 ± 3.4%.

CONCLUSIONS:

Aortic valve-sparing operations in patients with Marfan syndrome were associated with low rates of valve-related complications in long-term follow-up. Residual and new aortic dissections were the leading cause of death.

KEYWORDS:

aortic dissection; aortic root aneurysm; aortic insufficiency

PMID:
26403341
DOI:
10.1016/j.jacc.2015.07.041
[Indexed for MEDLINE]
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