title: Midterm results of David reimplantation in patients with connective tissue disorder.
abstract: BACKGROUND
  Few series have examined follow-up risks of the David reimplantation operation in patients with connective tissue disorder. Hence, we assessed its midterm safety and effectiveness for Marfan syndrome and other connective tissue disorders, such as Ehlers-Danlos, Loeys-Dietz, and marfanoid syndromes.
  
  
  METHODS
  Of 313 patients who underwent modified David reimplantation, 178 identified as having connective tissue disorders underwent operation from January 1, 1991, to December 31, 2010. These disorders included Marfan (84%), marfanoid (8.4%), Loeys-Dietz (5.6%), Ehlers-Danlos (1.1%), and other syndromes (1.1%). Concomitant procedures included mitral valve repair in 7.3% and an atrial fibrillation procedure in 3.4%.
  
  
  RESULTS
  There were no operative or 30-day deaths. Complications included prolonged ventilation (3%), renal failure (3%), reoperation for bleeding (2.2%), and permanent stroke (0.56%). Eight-year survival was 94% and freedom from aortic valve reoperation at 6 years was 92%. Of the 7 aortic valve reoperations, 3 were attributable to endocarditis and 3 to technical failure. One reoperation was performed at another hospital, and the reason could not be determined. There were no late strokes or hemorrhagic events. At 4 years, approximately 70% of patients had no aortic valve regurgitation, and 18% were in grade 1+.
  
  
  CONCLUSIONS
  Prophylactic root and valve preservation using David reimplantation is safe and provides excellent midterm effectiveness and low risk of late events except for endocarditis.
authors.affiliation: Marfan Syndrome and Connective Tissue Disorder Clinic, Cleveland, Ohio 44195, USA. svenssl@ccf.org
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: Mazin
authors.initials: M
authors.lastname: Alsalihi
authors.forename: Lillian H
authors.initials: LH
authors.lastname: Batizy
authors.forename: Eric E
authors.initials: EE
authors.lastname: Roselli
authors.forename: Rebecca
authors.initials: R
authors.lastname: McCullough
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vivacqua
authors.forename: Rocio T
authors.initials: RT
authors.lastname: Moran
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.forename: Maran
authors.initials: M
authors.lastname: Thamilarasan
authors.forename: Brian
authors.initials: B
authors.lastname: Griffin
authors.forename: Donald F
authors.initials: DF
authors.lastname: Hammer
authors.forename: William J
authors.initials: WJ
authors.lastname: Stewart
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sabik
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D003240:Connective Tissue Diseases / Q000150:complications*; D006349:Heart Valve Diseases / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors