title: Frequency of reoperations in patients with Marfan syndrome.
abstract: BACKGROUND
  We undertook a retrospective study of the pattern of reoperations in surgical patients with Marfan disease.
  
  
  METHODS
  Between 1985 and 2008, 83 Marfan patients (60 males, 23 females) underwent 155 aortic operations in our institution. Twenty-eight patients had acute dissection (22 type A, 6 type B), and two had aortic rupture. Mean age at initial operation was 32±13 years. Operations included valve-sparing or Bentall aortic root repair, and ascending aorta, arch, descending thoracic, thoracoabdominal aorta, and infrarenal aortic replacement. Sixty-one patients whose initial operation was elective (Group I) were compared with 22 patients with initial emergency surgery (Group II).
  
  
  RESULTS
  Overall, 81/83 patients ultimately underwent root/ascending repair: 64% initially and 36% at reoperation. Operative mortality in Group I was 1.6% for both initial operations and reoperations vs 9.0% and 0% in Group II. Significant differences between Group I and Group II patients included: total reoperations (1 vs 3, p=0.05); arch operations (0 vs 1, p=0.003); descending thoracic aortic operations (0 vs 0.5, p=0.003); and total aortic segments replaced (1.6±1.0 vs 2.4±1.1, p=0.001). Survival at 5 and 10 years did not differ between Group I and II patients (87% and 71% vs 82% and 56%, p=0.19).
  
  
  CONCLUSIONS
  Although reoperation occurs in about half of surgical Marfan patients, reoperative mortality is low. Patients with initial elective procedures fare better than those with initial emergency surgery: they have fewer subsequent operations, fewer aortic segments replaced, and trend toward improved survival. Elective root replacement should be seriously considered in any Marfan patient with significant root dilatation.
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York 10029, USA. sarah.geisbuesch@mountsinai.org
authors.forename: Sarah
authors.initials: S
authors.lastname: Geisbuesch
authors.forename: Deborah
authors.initials: D
authors.lastname: Schray
authors.forename: Moritz S
authors.initials: MS
authors.lastname: Bischoff
authors.forename: Hung-Mo
authors.initials: HM
authors.lastname: Lin
authors.forename: Gabriele
authors.initials: G
authors.lastname: Di Luozzo
authors.forename: Randall B
authors.initials: RB
authors.lastname: Griepp
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008382:Marfan Syndrome / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult