title: Adult surgical experience with Loeys-Dietz syndrome.
abstract: BACKGROUND
  Loeys-Dietz syndrome (LDS) results from mutations in receptors for the cytokine transforming growth factor-β leading to aggressive aortic pathology sometimes accompanied by specific phenotypic features including bifid uvula, hypertelorism, cleft palate, and generalized arterial tortuosity. We reviewed our adult surgical experience with LDS in order to validate current recommendations regarding management of this newly described disease.
  
  
  METHODS
  All adult (≥ 18 years old) patients with LDS undergoing surgical treatment at a single referral institution from September 1999 to May 2013 were retrospectively reviewed.
  
  
  RESULTS
  Eleven adult LDS patients were identified by clinical criteria and genotyping. Seven (64%) experienced acute type A dissection at some point in their lives. All eventually required aortic root replacement, and 73% required multiple vascular surgical interventions. Over a mean follow-up of 65 ± 49 months, 2.8 cardiovascular procedures per patient were performed. In patients with type A dissection, a mean of 3.4 operations were performed versus 1.8 operations for patients without dissection. Total aortic replacement was required in 5 patients (45%) and 2 (18%) required neurosurgical intervention for cerebrovascular pathology. There was 1 late death from infectious complications, and no deaths from vascular catastrophe.
  
  
  CONCLUSIONS
  These results confirm the aggressive nature of LDS aortic pathology. However, the improved survival compared with earlier LDS reports suggest that aggressive treatment strategies may alter outcomes and improve the natural history of this syndrome.
authors: Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Jason A
authors: JA
authors: Williams
authors: Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Jennifer M
authors: JM
authors: Hanna
authors: Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Asad A
authors: AA
authors: Shah
authors: Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Nicholas D
authors: ND
authors: Andersen
authors: Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, North Carolina.
authors: Marie T
authors: MT
authors: McDonald
authors: Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, North Carolina.
authors: Yong-Hui
authors: YH
authors: Jiang
authors: Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, North Carolina; Department of Pediatrics, Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors: Stephanie Burns
authors: SB
authors: Wechsler
authors: Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina.
authors: Ali
authors: A
authors: Zomorodi
authors: Division of Vascular Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Richard L
authors: RL
authors: McCann
authors: Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: gchad.hughes@duke.edu.
authors: G Chad
authors: GC
authors: Hughes
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000235:genetics / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000235:genetics / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D055947:Loeys-Dietz Syndrome / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011379:Prognosis; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult