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Late reoperation for proximal aortic and arch complications after previous composite graft replacement in Marfan

Teruhisa Kazui1, Katsushi Yamashita, Hitoshi Terada

  • 1First Department of Surgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu, Japan. tkazui@hama-med.ac.jp

The Annals of Thoracic Surgery
|October 8, 2003
PubMed
Abstract

Insights

For Marfan syndrome patients undergoing aortic graft replacement, the coronary button technique is preferred to minimize coronary complications. Early total arch replacement may prevent future aortic arch reoperations.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Medical Engineering

Background:

  • Marfan syndrome patients often require reoperation after composite graft replacement for proximal aortic disease.
  • The optimal initial surgical technique for proximal aortic disease in Marfan syndrome remains debated.

Purpose of the Study:

  • To evaluate reoperation outcomes in Marfan patients with composite graft replacement for annuloaortic ectasia.
  • To compare the effectiveness of different initial surgical techniques, including Bentall, Cabrol, and coronary button procedures.
  • To identify risk factors and recommend strategies for preventing late aortic complications.

Main Methods:

  • Retrospective analysis of 14 Marfan patients undergoing reoperation for composite graft complications.
  • Review of initial procedures: Bentall (11), Cabrol (2), coronary button (1).
  • Analysis of indications for reoperation (prosthesis-related, distal aorta) and reoperative procedures performed.

Main Results:

  • In-hospital mortality was 14.3% (2 deaths).
  • Coronary artery pseudoaneurysms occurred with Bentall and Cabrol procedures; true aneurysms were seen even with the coronary button technique.
  • Six patients required subsequent aortic replacements for distal aneurysmal formation.

Conclusions:

  • The coronary button technique is recommended for annuloaortic ectasia due to reduced coronary artery complications.
  • Concomitant total arch replacement may be beneficial for selected Marfan patients with DeBakey type I aortic dissection to prevent arch reoperation.

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