Early and 1-year outcomes of aortic root surgery in patients with Marfan syndrome: A prospective, multicenter, comparative study

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 147; no. 6; pp. 1758 - 1767.e4
• Main Authors: Coselli, Joseph S., MD, Volguina, Irina V., PhD, LeMaire, Scott A., MD, Sundt, Thoralf M., MD, Connolly, Heidi M., MD, Stephens, Elizabeth H., MD, PhD, Schaff, Hartzell V., MD, Milewicz, Dianna M., MD, PhD, Vricella, Luca A., MD, Dietz, Harry C., MD, Minard, Charles G., PhD, Miller, D. Craig, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.06.2014
• Subjects: Adolescent; Adult; Aged; Aortic Aneurysm - diagnosis; Aortic Aneurysm - etiology; Aortic Aneurysm - mortality; Aortic Aneurysm - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Cardiothoracic Surgery; Chi-Square Distribution; Child; Child, Preschool; Female; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - mortality; Humans; Kaplan-Meier Estimate; Male; Marfan Syndrome - complications; Marfan Syndrome - diagnosis; Marfan Syndrome - mortality; Middle Aged; Multivariate Analysis; Postoperative Complications - surgery; Proportional Hazards Models; Prospective Studies; Registries; Reoperation; Risk Factors; Time Factors; Treatment Outcome; Young Adult; nonstructural valve dysfunction; NYHA; SVD; 35; 26; aortic valve-replacing; MAVRE; major adverse valve-related event; Marfan syndrome; AR; New York Heart Association; aortic regurgitation; NSVD; structural valve deterioration; MFS; AVR; AVS; aortic valve-sparing
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2014.02.021

Objective To compare the 1-year results after aortic valve-sparing (AVS) or valve-replacing (AVR) aortic root replacement from a prospective, international registry of 316 patients with Marfan syndrome (MFS). Methods Patients underwent AVS (n = 239, 76%) or AVR (n = 77, 24%) aortic root replacement at 19 participating centers from 2005 to 2010. One-year follow-up data were complete for 312 patients (99%), with imaging findings available for 293 (94%). The time-to-events were compared between groups using Kaplan-Meier curves and Cox proportional hazards models. Results Two patients (0.6%)—1 in each group—died within 30 days. No significant differences were found in early major adverse valve-related events (MAVRE; P  = .6). Two AVS patients required early reoperation for coronary artery complications. The 1-year survival rates were similar in the AVR (97%) and AVS (98%) groups; the procedure type was not significantly associated with any valve-related events. At 1 year and beyond, aortic regurgitation of at least moderate severity (≥2+) was present in 16 patients in the AVS group (7%) but in no patients in the AVR group ( P  = .02). One AVS patient required late AVR. Conclusions AVS aortic root replacement was not associated with greater 30-day mortality or morbidity rates than AVR root replacement. At 1 year, no differences were found in survival, valve-related morbidity, or MAVRE between the AVS and AVR groups. Of concern, 7% of AVS patients developed grade ≥2+ aortic regurgitation, emphasizing the importance of 5 to 10 years of follow-up to learn the long-term durability of AVS versus AVR root replacement in patients with MFS.