title: Aortic root replacement in 271 Marfan patients: a 24-year experience.
abstract: BACKGROUND
  The introduction of composite graft repair of aortic root aneurysm by Hugh Bentall in 1968 promised Marfan patients the choice for a normal life expectancy. We performed our first Bentall composite graft procedure in 1976 and herein report our 24-year experience with 271 Marfan patients.
  
  
  METHODS
  Between September 1976 and August 2000, 232 Marfan patients had a composite graft replacement of the aortic root, 15 patients received a homograft, and 24 had a valve-sparing procedure.
  
  
  RESULTS
  Two hundred thirty-five Marfan patients underwent elective aortic root replacement with no 30-day mortality. Two early deaths occurred among 36 patients who underwent urgent or emergent operation. Eighty-three percent of patients in this series are currently alive. The actuarial freedom from thromboembolism, endocarditis, and reoperation on the residual aorta 20 years postoperatively was 93%, 90%, and 74%. Twenty-four patients have undergone valve-sparing procedures with encouraging results.
  
  
  CONCLUSIONS
  Elective aortic root replacement for Marfan patients can be performed with low operative risk. Elective repair before the aortic root reaches 6 cm in diameter is recommended to minimize risk of dissection and rupture.
authors.affiliation: Division of Cardiac Surgery, the Institute of Genetic Medicine and the Howard Hughes Medical Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. vgott@csurg.jhmi.jhu.edu
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Gott
authors.forename: Duke E
authors.initials: DE
authors.lastname: Cameron
authors.forename: Diane E
authors.initials: DE
authors.lastname: Alejo
authors.forename: Peter S
authors.initials: PS
authors.lastname: Greene
authors.forename: Jay G
authors.initials: JG
authors.lastname: Shake
authors.forename: David J
authors.initials: DJ
authors.lastname: Caparrelli
authors.forename: Harry C
authors.initials: HC
authors.lastname: Dietz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006351:Heart Valves / Q000637:transplantation; D006801:Humans; D007223:Infant; D008297:Male; D008382:Marfan Syndrome / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D016019:Survival Analysis; D014184:Transplantation, Homologous