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Aortic root operations for Marfan syndrome: a comparison of the Bentall and valve-sparing procedures

Nishant D Patel1, Eric S Weiss, Diane E Alejo

  • 1Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

The Annals of Thoracic Surgery
|May 24, 2008
PubMed
Abstract

Insights

The Bentall procedure and valve-sparing aortic root replacement (VSRR) show similar early outcomes for Marfan syndrome patients. Bentall surgery had more thromboembolism, while VSRR had more reoperations and lower late survival.

Area of Science:

  • Cardiovascular Surgery
  • Genetics
  • Thoracic Surgery

Background:

  • Marfan syndrome is a genetic disorder affecting connective tissue, often leading to aortic root aneurysm.
  • Surgical repair of the aortic root is crucial for Marfan syndrome patients to prevent catastrophic aortic events.

Purpose of the Study:

  • To compare the outcomes of the Bentall procedure versus valve-sparing aortic root replacement (VSRR) in patients with Marfan syndrome and aortic root aneurysm.
  • To evaluate operative results, survival rates, and reoperation rates between the two surgical techniques.

Main Methods:

  • A retrospective review of Marfan syndrome patients who underwent either the Bentall procedure or VSRR between 1997 and 2006.
  • Kaplan-Meier survival analysis and propensity score analysis were employed to compare outcomes.
  • Follow-up data were collected from hospital records and patient/physician contact.

Main Results:

  • 140 Marfan syndrome patients were analyzed: 56 underwent the Bentall procedure and 84 underwent VSRR.
  • Bentall patients were older and presented with more complex aortic conditions, including dissections and severe aortic insufficiency.
  • Postoperative thromboembolic events were higher in the Bentall group (9% vs 1%), while VSRR had a higher reoperation rate (6% vs 2%). Eight-year survival was 90% for Bentall and 100% for VSRR.

Conclusions:

  • Both the Bentall procedure and VSRR demonstrate comparable early operative results in Marfan syndrome.
  • Key differences include a higher incidence of thromboembolism with the Bentall procedure and a greater need for reoperation with VSRR.
  • The lower late survival observed in the Bentall group likely stems from its application in higher-risk patient cohorts.

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