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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Should We Replace the Non-Aneurysmal Aortic Arch During Elective Valve-Sparing Aortic Root Replacement in Marfan

Malakh Shrestha1,2, Tim Kaufeld2, Linda Rudolph2

  • 1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, Unites States.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|December 24, 2025
PubMed
Abstract

Insights

For Marfan patients undergoing valve-sparing aortic root replacement, prophylactic aortic arch replacement is not necessary. Long-term follow-up shows a very low risk of future aortic arch intervention, supporting isolated aortic root repair.

Area of Science:

  • Cardiovascular Surgery
  • Genetics
  • Thoracic Surgery

Background:

  • Valve-sparing aortic root replacement (VSARR) is increasingly used for Marfan syndrome.
  • Debate exists on whether to prophylactically replace the non-aneurysmal aortic arch during VSARR.

Purpose of the Study:

  • To evaluate the long-term status of the aortic arch in Marfan patients after isolated VSARR.
  • To determine the necessity of concomitant prophylactic aortic arch replacement.

Main Methods:

  • Retrospective study of 67 Marfan patients who underwent isolated David I procedure (VSARR) between 1993 and 2021.
  • Exclusion of patients with aortic arch pathology at the time of surgery.
  • 100% complete follow-up to assess aortic arch status and reoperation rates.

Main Results:

  • Excellent survival rates at 20 years (85%).
  • High freedom from aortic arch reoperation due to aneurysm (95% at 20 years).
  • No patient required aortic arch replacement for aneurysm; 3 underwent replacement for type B aortic dissection.

Conclusions:

  • Isolated VSARR in Marfan patients yields excellent long-term outcomes.
  • The risk of future aortic arch intervention after isolated VSARR is very low.
  • Prophylactic aortic arch replacement is not indicated in Marfan patients with non-aneurysmal aortic arches undergoing elective VSARR.
Keywords:
David operationMarfan syndromeaortic arch replacementaortic valve-sparing root replacement

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