TY - JOUR
T1 - Long-term outcomes of aortic root operations for Marfan syndrome
T2 - A comparison of Bentall versus aortic valve-sparing procedures Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015.
AU - Price, Joel
AU - Magruder, J. Trent
AU - Young, Allen
AU - Grimm, Joshua C.
AU - Patel, Nishant D.
AU - Alejo, Diane
AU - Dietz, Harry C.
AU - Vricella, Luca A.
AU - Cameron, Duke E.
N1 - Publisher Copyright:
© 2016 The American Association for Thoracic Surgery.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Objectives Prophylactic aortic root replacement improves survival in patients with Marfan syndrome with aortic root aneurysms, but the optimal procedure remains undefined. Methods Adult patients with Marfan syndrome who had Bentall or aortic valve-sparing root replacement (VSRR) procedures between 1997 and 2013 were identified. Comprehensive follow-up information was obtained from hospital charts and telephone contact. Results One hundred sixty-five adult patients with Marfan syndrome (aged > 20 years) had either VSRR (n = 98; 69 reimplantation, 29 remodeling) or Bentall (n = 67) procedures. Patients undergoing Bentall procedure were older (median, 37 vs 36 years; P =.03), had larger median preoperative sinus diameter (5.5 cm vs 5.0 cm; P =.003), more aortic dissections (25.4% vs 4.1%; P <.001), higher incidence of moderate or severe aortic insufficiency (49.3% vs 14.4%; P <.001) and more urgent or emergent operations (24.6% vs 3.3%; P <.001). There were no hospital deaths and 9 late deaths in more than 17 years of follow-up (median, 7.8 deaths). Ten-year survival was 90.5% in patients undergoing Bentall procedure and 96.3% in patients undergoing VSRR (P =.10). Multivariable analysis revealed that VSRR was associated with fewer thromboembolic or hemorrhagic events (hazard ratio, 0.16; 95% confidence interval, 0.03-0.85; P =.03). There was no independent difference in long-term survival, freedom from reoperation, or freedom from endocarditis between the 2 procedures. Conclusions After prophylactic root replacement in patients with Marfan syndrome, patients undergoing Bentall and valve-sparing procedures have similar late survival, freedom from root reoperation, and freedom from endocarditis. However, valve-sparing procedures result in significantly fewer thromboembolic and hemorrhagic events.
AB - Objectives Prophylactic aortic root replacement improves survival in patients with Marfan syndrome with aortic root aneurysms, but the optimal procedure remains undefined. Methods Adult patients with Marfan syndrome who had Bentall or aortic valve-sparing root replacement (VSRR) procedures between 1997 and 2013 were identified. Comprehensive follow-up information was obtained from hospital charts and telephone contact. Results One hundred sixty-five adult patients with Marfan syndrome (aged > 20 years) had either VSRR (n = 98; 69 reimplantation, 29 remodeling) or Bentall (n = 67) procedures. Patients undergoing Bentall procedure were older (median, 37 vs 36 years; P =.03), had larger median preoperative sinus diameter (5.5 cm vs 5.0 cm; P =.003), more aortic dissections (25.4% vs 4.1%; P <.001), higher incidence of moderate or severe aortic insufficiency (49.3% vs 14.4%; P <.001) and more urgent or emergent operations (24.6% vs 3.3%; P <.001). There were no hospital deaths and 9 late deaths in more than 17 years of follow-up (median, 7.8 deaths). Ten-year survival was 90.5% in patients undergoing Bentall procedure and 96.3% in patients undergoing VSRR (P =.10). Multivariable analysis revealed that VSRR was associated with fewer thromboembolic or hemorrhagic events (hazard ratio, 0.16; 95% confidence interval, 0.03-0.85; P =.03). There was no independent difference in long-term survival, freedom from reoperation, or freedom from endocarditis between the 2 procedures. Conclusions After prophylactic root replacement in patients with Marfan syndrome, patients undergoing Bentall and valve-sparing procedures have similar late survival, freedom from root reoperation, and freedom from endocarditis. However, valve-sparing procedures result in significantly fewer thromboembolic and hemorrhagic events.
KW - Marfan syndrome
KW - aortic root replacement
KW - aortic valve-sparing root replacement
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U2 - 10.1016/j.jtcvs.2015.10.068
DO - 10.1016/j.jtcvs.2015.10.068
M3 - Article
C2 - 26704057
AN - SCOPUS:84957428864
SN - 0022-5223
VL - 151
SP - 330
EP - 338
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 2
ER -