Aortic valve-sparing operation in Marfan syndrome: what do we know after a decade?

Abstract

BACKGROUND:

We assessed the outcome in patients with Marfan syndrome operated on exclusively with the aortic valve-sparing reimplantation technique for aortic root aneurysms during more than a decade.

METHODS:

Between July 1993 and April 2005, the aortic valve-sparing reimplantation technique (David I) was used in 325 patients. In 59 patients with clinical evidence of Marfan syndrome, procedures were done for aortic root aneurysm (n = 55) or aortic dissection type A (n = 4). Their mean age was 30 +/- 12 years (range, 9 to 62 years), and 37 (63%) were male. Additional procedures were arch replacement in 4 patients, coronary artery bypass grafting in 1, mitral valve surgery in 9, and closure of atrial septal defect in 3. Mean follow-up was 54 +/- 37 months (range, 0 to 139 months).

RESULTS:

No patient died during the first 30 days postoperatively. Mean bypass time was 163 +/- 34 minutes (range, 99 to 248 minutes), and mean aortic cross clamp time was 126 +/- 28 minutes (range, 78 to 202 minutes). Four patients (6.8%) required rethoracotomy for postoperative bleeding. Five late deaths (8.5%) occurred during follow-up. Reoperation of the reconstructed valve was required in 7 patients. Freedom from reoperation was 88% +/- 5% at 5 years and 80% +/- 9% at 10 years. Mean grade of aortic insufficiency was 1.81 preoperatively compared with 0.20 early postoperatively (p < 0.001). At last investigation, the mean grade of aortic insufficiency increased slightly to 0.22 (p = 0.16). Anticoagulation was not required in 67% of patients. One thromboembolic complication and four instances of minor bleeding were documented. All patients were in New York Heart Association functional class I (86%) or II at last contact.

CONCLUSIONS:

Excellent early outcome, favorable long-term results, and acceptable durability of the reimplanted valve should encourage use of this technique in patients with Marfan syndrome.

• Authors: Klaus Kallenbach, Hassina Baraki, Nawid Khaladj, Hiroyuki Kamiya, Christian Hagl, Axel Haverich, Matthias Karck
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 83 Issue 2 Pg. S764-8; discussion S785-90 (Feb 2007) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 17257923 (Publication Type: Journal Article)

Chemical References

• Anticoagulants

Topics

• Adolescent
• Adult
• Aortic Dissection (complications, etiology, surgery)
• Anticoagulants (therapeutic use)
• Aortic Aneurysm (complications, etiology, surgery)
• Aortic Valve (surgery)
• Aortic Valve Insufficiency (etiology, physiopathology)
• Child
• Female
• Follow-Up Studies
• Hemorrhage (etiology, surgery)
• Humans
• Male
• Marfan Syndrome (complications)
• Middle Aged
• Reoperation
• Replantation
• Thoracotomy
• Thromboembolism (etiology)
• Vascular Surgical Procedures (adverse effects, mortality)