Aortic root surgery in Marfan syndrome: comparison of aortic valve-sparing reimplantation versus composite grafting

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 127; no. 2; pp. 391 - 398
• Main Authors: Karck, Matthias, Kallenbach, Klaus, Hagl, Christian, Rhein, Christine, Leyh, Rainer, Haverich, Axel
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.02.2004; AATS/WTSA
• Subjects: Adolescent; Adult; Age Factors; Aged; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aorta - surgery; Aortic Aneurysm - mortality; Aortic Aneurysm - surgery; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Child; Cohort Studies; Echocardiography, Doppler; Female; Follow-Up Studies; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation; Hospital Mortality; Humans; Length of Stay; Male; Marfan Syndrome - mortality; Marfan Syndrome - surgery; Middle Aged; Morbidity; Postoperative Complications - etiology; Postoperative Complications - mortality; Reoperation; Severity of Illness Index; Time Factors; Treatment Outcome; 26; 35
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2003.07.049

The objective of this study was to compare the results of aortic valve-sparing reimplantation and aortic root replacement with mechanical valve conduits in patients with Marfan syndrome undergoing operation for aortic root aneurysms. Between March 1979 and April 2002, 119 patients with clinical evidence of Marfan syndrome underwent composite graft replacement with mechanical valve conduits (n = 74) or aortic valve-sparing reimplantation according to David (n = 45). The underlying causes were aortic dissection type A (43 patients) and aneurysms (76 patients). Patients undergoing aortic valve reimplantation were younger compared with patients undergoing composite grafting (28 vs 35 years, P = .002) and had longer intraoperative aortic crossclamp times (125 vs 78 minutes, P < .0001) and extracorporeal circulation times (162 vs 124 minutes, P < .0001). Early postoperative mortality was 6.8% (n = 5) in patients undergoing composite grafting and 0% in patients undergoing aortic valve reimplantation ( P = .15). Mean follow-up was 30 months for patients undergoing aortic valve reimplantation and 114 months for patients undergoing composite grafting. Freedom from reoperation and death after 5 years postoperatively was 92% and 89% in patients undergoing composite grafting and 84% and 96% in patients undergoing aortic valve reimplantation ( P = .31; P = .54), respectively. Thromboembolic complications or late postoperative bleeding occurred in 17 patients undergoing composite grafting, and an early postoperative event occurred in 1 patient undergoing aortic valve reimplantation. The results of aortic valve reimplantation and composite grafting of the aortic valve and ascending aorta with mechanical valve conduits are similar with regard to early and mid-term postoperative mortality and to the incidence of late reoperations in patients with Marfan syndrome. The low risk of thromboembolic or bleeding complications favors aortic valve reimplantation in these patients.