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Aortic root replacement in 271 Marfan patients: a 24-year experience
Vincent L Gott1, Duke E Cameron, Diane E Alejo
1Division of Cardiac Surgery, the Institute of Genetic Medicine and the Howard Hughes Medical Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. vgott@csurg.jhmi.jhu.edu
The Annals of Thoracic Surgery
|February 16, 2002
Summary
Composite graft repair offers Marfan syndrome patients improved life expectancy. This 24-year study of 271 patients shows elective aortic root replacement is safe and effective, with high long-term survival rates.
Area of Science:
- Cardiovascular Surgery
- Genetics
- Aortic Diseases
Background:
- The Bentall composite graft procedure, introduced in 1968, aimed to provide Marfan syndrome patients with normal life expectancy.
- This study reports on a 24-year experience with 271 Marfan patients undergoing aortic root repair.
Purpose of the Study:
- To evaluate the long-term outcomes of composite graft repair for aortic root aneurysms in Marfan syndrome patients.
- To assess the safety and efficacy of elective versus urgent aortic root replacement.
Main Methods:
- A retrospective review of 271 Marfan patients undergoing aortic root replacement between 1976 and 2000.
- Procedures included composite graft replacement (n=232), homograft (n=15), and valve-sparing procedures (n=24).
Main Results:
- No 30-day mortality occurred in 235 elective aortic root replacements.
- Actuarial freedom from thromboembolism, endocarditis, and reoperation at 20 years was 93%, 90%, and 74%, respectively.
- Eighty-three percent of patients remain alive, with encouraging results from valve-sparing procedures.
Conclusions:
- Elective aortic root replacement for Marfan patients can be performed with low operative risk.
- Repair is recommended before the aortic root diameter reaches 6 cm to minimize risks of dissection and rupture.