Composite graft repair of Marfan aneurysm of the ascending aorta: Results in 150 patients

Vincent L Gott, D. E. Cameron, R. E. Pyeritz, A. M. Gillinov, Peter Schuyler Greene, C. D. Stone, D. E. Alejo, V. A. McKusick

Research output: Contribution to journalArticle

Abstract

One hundred fifty consecutive Marfan patients undergoing composite graft repair of an ascending aorta aneurysm are reported. Twenty-six of the 150 patients had a preoperative dissection of the ascending aorta. There were no early deaths among 138 patients undergoing elective composite graft repair. There was one early death among 12 patients undergoing urgent operation; this patient arrived at the hospital with a rupturing aneurysm. Twenty-four of the 150 patients had mitral procedures; there were no early deaths in this group. There have been 14 late deaths among the 149 hospital survivors (9%). Actuarial survival of 150 patients at 1, 5, 10, and 14 years was 93%, 92%, 81%, and 73% respectively. Risk factors for early or late death were identified by multivariate analysis and only New York Heart Association class (III or IV) and male gender emerged as significant independent predictors of mortality. Late complications directly related to the composite graft have been gratifyingly low; only 2 patients had coronary dehiscence and 3 had thromboembolic events. Endocarditis emerged as an important late complication in 8 patients (5%). Two patients were successfully treated with antibiotics, 3 died before widespread availability of cryopreserved homografts, and 3 patients treated with antibiotics and homograft root replacement have had no evidence of recurrent infection. Seven patients with dissection in this series had aortic diameters of 6.5 cm or less. This experience supports the concept that composite graft repair in Marfan patients is mandated when the aneurysm reaches 5.5 to 6 cm, even in the asymptomatic patient. With a family history of dissection, operative intervention should occur when the aneurysm reaches 5 cm in diameter.

Original languageEnglish (US)
Pages (from-to)482-489
Number of pages8
JournalJournal of Cardiac Surgery
Volume9
Issue number5
StatePublished - 1994

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Aneurysm
Aorta
Transplants
Dissection
Allografts
Anti-Bacterial Agents
Endocarditis
Survivors
Multivariate Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Gott, V. L., Cameron, D. E., Pyeritz, R. E., Gillinov, A. M., Greene, P. S., Stone, C. D., ... McKusick, V. A. (1994). Composite graft repair of Marfan aneurysm of the ascending aorta: Results in 150 patients. Journal of Cardiac Surgery, 9(5), 482-489.

Composite graft repair of Marfan aneurysm of the ascending aorta : Results in 150 patients. / Gott, Vincent L; Cameron, D. E.; Pyeritz, R. E.; Gillinov, A. M.; Greene, Peter Schuyler; Stone, C. D.; Alejo, D. E.; McKusick, V. A.

In: Journal of Cardiac Surgery, Vol. 9, No. 5, 1994, p. 482-489.

Research output: Contribution to journalArticle

Gott, VL, Cameron, DE, Pyeritz, RE, Gillinov, AM, Greene, PS, Stone, CD, Alejo, DE & McKusick, VA 1994, 'Composite graft repair of Marfan aneurysm of the ascending aorta: Results in 150 patients', Journal of Cardiac Surgery, vol. 9, no. 5, pp. 482-489.
Gott, Vincent L ; Cameron, D. E. ; Pyeritz, R. E. ; Gillinov, A. M. ; Greene, Peter Schuyler ; Stone, C. D. ; Alejo, D. E. ; McKusick, V. A. / Composite graft repair of Marfan aneurysm of the ascending aorta : Results in 150 patients. In: Journal of Cardiac Surgery. 1994 ; Vol. 9, No. 5. pp. 482-489.
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