New composite graft repair for patients with and without Marfan's syndrome

We developed a new composite graft repair technique to prevent the complications associated with Bentall-type procedures. The technique consists of the creation of a double proximal suture line and direct coronary artery implantation as a Carrel patch without wrapping. We retrospectively compared the outcome in patients with Marfan's syndrome (n = 16) and other disorders (aortitis, 11 patients; degenerative disease, 18 patients) who had undergone this procedure. In patients with Marfan's syndrome, there was one hospital death and six deaths during long-term follow-up. Among patients with Takayasu's arteritis, there was one hospital death and one late death. There was one late death in the patients with degenerative disease. No mortality or complications directly related to the surgical procedure occurred in any group. The high late mortality in patients with Marfan's syndrome was primarily due to distal aortic dissection or rupture. Thus, the major complications associated with Bentall-type procedures can be prevented through the use of our new composite graft technique. However, close serial follow-up, careful blood pressure control, and early detection and treatment of distal recurrence are mandatory in the postoperative management of patients with Marfan's syndrome.