title: Late reoperation for proximal aortic and arch complications after previous composite graft replacement in Marfan patients.
abstract: BACKGROUND
  Marfan patients who received composite graft replacement for proximal aortic disease frequently require late reoperation. The initial surgical technique for this lesion remains controversial.
  
  
  METHODS
  Fourteen Marfan patients who received composite graft replacement for annuloaortic ectasia with or without aortic dissection required late reoperation thorough re-median sternotomy. The techniques used for an initial composite graft replacement were the original Bentall procedure in 11 patients, the Cabrol procedure in 2, and coronary button technique in 1. Reoperation was indicated for prosthesis-related complications in 10 patients, distal aortic lesion in 13, or for both lesions in 8. Reoperations were performed, on average, 8.4 years after an initial operation. Reoperative procedures included re-composite graft replacement in 1 patient, total arch replacement in 5, and re-composite graft replacement with total arch replacement in 8.
  
  
  RESULTS
  There were two in-hospital deaths (14.3%). Although pseudoaneurysms of the coronary artery or distal aorta occurred in the original Bentall or Cabrol procedures, true aneurysms of the coronary artery were noted even in the coronary button technique. Six patients required a total of eight subsequent descending or thoracoabdominal aortic replacements for an aneurysmal formation of a distal false lumen.
  
  
  CONCLUSIONS
  The coronary button technique, with a small side hole for coronary anastomosis, is the procedure of choice for annuloaortic ectasia because it reduces the risk of coronary artery-related complications. Concomitant total arch replacement may be recommended for annuloaortic ectasia with DeBakey type I aortic dissection in selected patients to avoid the risk of reoperation on the aortic arch.
authors.affiliation: First Department of Surgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu, Japan. tkazui@hama-med.ac.jp
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Kazui
authors.forename: Katsushi
authors.initials: K
authors.lastname: Yamashita
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Terada
authors.forename: Naoki
authors.initials: N
authors.lastname: Washiyama
authors.forename: Takayasu
authors.initials: T
authors.lastname: Suzuki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ohkura
authors.forename: Kazuchika
authors.initials: K
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D003323:Coronary Aneurysm / Q000601:surgery; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D013997:Time Factors