Aortic root surgery in Marfan syndrome.
BACKGROUND
As the shortcomings of the Bentall operation and its variants in the Marfan syndrome have become apparent, the recent cusp-sparing techniques (remodeling or reimplantation) bear promise of better mid-term and long-term outcomes.


OBJECTIVE
To examine the results of aortic root surgery in patients with Marfan syndrome.


METHODS
During the period March 1994 to September 2007, 220 patients underwent aortic valve-sparing surgery; 20 were Marfan patients (group 1) who were compared with another 20 Marfan patients undergoing composite aortic root replacement (group 2). Fourteen patients had aortic dissection and 26 had thoracic aortic aneurysm. There were 31 males and 9 females with a mean age of 37.9 +/- 13.8 years. In group 1, reimplantation was used in 13 patients, remodeling in 4, and aortic valve repair with sinotubular junction replacement in 3. In group 2, a mechanical valve conduit was used. Mean logistic Euroscore was 12.27 +/- 14.6% for the whole group, five of whom were emergent cases


RESULTS
Group 2 had more previous cardiac procedures compared to group 1 (9 vs. 2, P = 0.03) and shorter cross-clamp time (122 +/- 27.1 vs. 153.9 +/- 23.7 minutes, P = 0.0004). Overall mortality was 10%. Early mortality was 10% in group 2 and 5% in group 1 (NS). Mean follow-up time was 25 months for group 2 and 53 months for group 1. Three patients were reoperated; all had undergone the remodeling. Five year freedom from reoperation and death was 86% and 90% in group 2 and 70% and 95% in group 1 (P = 0.6, P = 0.6), respectively.


CONCLUSIONS
Late survival of patients with Marfan syndrome was similar in both groups. Root reconstruction tends towards a higher incidence of late reoperations if the remodeling technique is used. We now prefer to use the reimplantation technique.
Sheick-Yousif
Basheer
B
Department of Cardiothoracic Surgery, Sheba Medical Center, Tel Hashomer, Israel. basheers@zahav.net.il
Sheinfield
Ami
A
Tager
Salis
S
Ghosh
Probal
P
Priesman
Sergey
S
Smolinsky
Aram K
AK
Raanani
Ehud
E
D000328:Adult; D000784:Aortic Dissection / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D001013:Aorta, Thoracic; D001014:Aortic Aneurysm / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D001021:Aortic Valve; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications* / Q000401:mortality / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome