Aortic valve-sparing operation in Marfan syndrome: what do we know after a decade?
BACKGROUND
We assessed the outcome in patients with Marfan syndrome operated on exclusively with the aortic valve-sparing reimplantation technique for aortic root aneurysms during more than a decade.


METHODS
Between July 1993 and April 2005, the aortic valve-sparing reimplantation technique (David I) was used in 325 patients. In 59 patients with clinical evidence of Marfan syndrome, procedures were done for aortic root aneurysm (n = 55) or aortic dissection type A (n = 4). Their mean age was 30 +/- 12 years (range, 9 to 62 years), and 37 (63%) were male. Additional procedures were arch replacement in 4 patients, coronary artery bypass grafting in 1, mitral valve surgery in 9, and closure of atrial septal defect in 3. Mean follow-up was 54 +/- 37 months (range, 0 to 139 months).


RESULTS
No patient died during the first 30 days postoperatively. Mean bypass time was 163 +/- 34 minutes (range, 99 to 248 minutes), and mean aortic cross clamp time was 126 +/- 28 minutes (range, 78 to 202 minutes). Four patients (6.8%) required rethoracotomy for postoperative bleeding. Five late deaths (8.5%) occurred during follow-up. Reoperation of the reconstructed valve was required in 7 patients. Freedom from reoperation was 88% +/- 5% at 5 years and 80% +/- 9% at 10 years. Mean grade of aortic insufficiency was 1.81 preoperatively compared with 0.20 early postoperatively (p < 0.001). At last investigation, the mean grade of aortic insufficiency increased slightly to 0.22 (p = 0.16). Anticoagulation was not required in 67% of patients. One thromboembolic complication and four instances of minor bleeding were documented. All patients were in New York Heart Association functional class I (86%) or II at last contact.


CONCLUSIONS
Excellent early outcome, favorable long-term results, and acceptable durability of the reimplanted valve should encourage use of this technique in patients with Marfan syndrome.
Kallenbach
Klaus
K
Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany. klaus.kallenbach@med.uni-heidelberg.de
Baraki
Hassina
H
Khaladj
Nawid
N
Kamiya
Hiroyuki
H
Hagl
Christian
C
Haverich
Axel
A
Karck
Matthias
M
D000293:Adolescent; D000328:Adult; D000784:Aortic Dissection / Q000150:complications / Q000209:etiology / Q000601:surgery*; D000925:Anticoagulants / Q000627:therapeutic use; D001014:Aortic Aneurysm / Q000150:complications / Q000209:etiology / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000503:physiopathology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications*; D008875:Middle Aged; D012086:Reoperation; D012092:Replantation; D013908:Thoracotomy; D013923:Thromboembolism / Q000209:etiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
D000925:Anticoagulants