TY - JOUR
T1 - Midterm outcomes of aortic root surgery in patients with Marfan syndrome
T2 - A prospective, multicenter, comparative study
AU - Aortic Valve Operative Outcomes in Marfan Patients Study Group
AU - Coselli, Joseph S.
AU - Volguina, Irina V.
AU - LeMaire, Scott A.
AU - Connolly, Heidi M.
AU - Sundt, Thoralf M.
AU - Milewicz, Dianna M.
AU - Dietz, Harry C.
AU - Amarasekara, Hiruni S.
AU - Green, Susan Y.
AU - Zhang, Qianzi
AU - Schaff, Hartzell V.
AU - Miller, D. Craig
N1 - Funding Information:
J.S.C. participates in clinical studies with and/or consults for Terumo Aortic, Medtronic, W.L. Gore & Associates, CytoSorbents, and Abbott Laboratories and receives royalties and grant support from Terumo Aortic , The Marfan Foundation , and Stanford University . J.S.C.'s work is supported in part by the Cullen Foundation . S.A.L. has served as a consultant for Terumo Aortic, Cerus, and Baxter Healthcare; has served as an Advisory Board Member for Biom'up and Acer Therapeutics; has served as a principal investigator for clinical studies sponsored by Terumo Aortic , CytoSorbents , and Baxter Healthcare ; and has served as a co-investigator for clinical studies sponsored by Medtronic , Inc, W.L. Gore & Associates , and CytoSorbents , Inc. S.A.L.'s work is supported in part by the Jimmy and Roberta Howell Professorship in Cardiovascular Surgery at Baylor College of Medicine . All other authors reported no conflicts of interest.
Funding Information:
This study was sponsored by The Marfan Foundation (formally the National Marfan Foundation), the Michael E. DeBakey Department of Surgery at Baylor College of Medicine, and the Department of Cardiothoracic Surgery of Stanford University School of Medicine. The Marfan Foundation received unrestricted support from Vascutek Ltd, St. Jude Medical, Inc, Maquet Cardiovascular/Getinge Group, and Broccoli Center for Aortic Diseases, Johns Hopkins Medicine. Funding agencies outside of Baylor College of Medicine and Stanford University had no role in data analysis or interpretation.J.S.C. participates in clinical studies with and/or consults for Terumo Aortic, Medtronic, W.L. Gore & Associates, CytoSorbents, and Abbott Laboratories and receives royalties and grant support from Terumo Aortic, The Marfan Foundation, and Stanford University. J.S.C.'s work is supported in part by the Cullen Foundation. S.A.L. has served as a consultant for Terumo Aortic, Cerus, and Baxter Healthcare; has served as an Advisory Board Member for Biom'up and Acer Therapeutics; has served as a principal investigator for clinical studies sponsored by Terumo Aortic, CytoSorbents, and Baxter Healthcare; and has served as a co-investigator for clinical studies sponsored by Medtronic, Inc, W.L. Gore & Associates, and CytoSorbents, Inc. S.A.L.'s work is supported in part by the Jimmy and Roberta Howell Professorship in Cardiovascular Surgery at Baylor College of Medicine. All other authors reported no conflicts of interest.
Funding Information:
This study was sponsored by The Marfan Foundation (formally the National Marfan Foundation ), the Michael E. DeBakey Department of Surgery at Baylor College of Medicine , and the Department of Cardiothoracic Surgery of Stanford University School of Medicine . The Marfan Foundation received unrestricted support from Vascutek Ltd , St. Jude Medical, Inc , Maquet Cardiovascular /Getinge Group, and Broccoli Center for Aortic Diseases, Johns Hopkins Medicine . Funding agencies outside of Baylor College of Medicine and Stanford University had no role in data analysis or interpretation.
Publisher Copyright:
© 2021 The American Association for Thoracic Surgery
PY - 2021
Y1 - 2021
N2 - Objective: The objective of this study was to compare midterm outcomes of aortic valve-replacing root replacement (AVR) and aortic valve-sparing root replacement (AVS) operations in patients with Marfan syndrome. Methods: Patients who met strict Ghent diagnostic criteria for Marfan syndrome and who underwent either AVR or AVS between March 1, 2005 and December 31, 2010 were enrolled in a 3-year follow-up prospective, multicenter, international registry study; the study was subsequently amended to include 20-year follow-up. Enrollees were followed clinically and echocardiographically. Results: Of the 316 patients enrolled, 77 underwent AVR and 239 underwent AVS; 214 gave reconsent for 20-year follow-up. The median clinical follow-up time for surviving patients was 64 months (interquartile range, 42-66 months). Survival rates for the AVR and AVS groups were similar at 88.2% ± 4.4% and 95.0% ± 1.5%, respectively (P = .1). Propensity score-adjusted competing risk modeling showed associations between AVS and higher cumulative incidences of major adverse valve-related events, valve-related morbidity, combined structural valve deterioration and nonstructural valve dysfunction, and aortic regurgitation ≥2+ (all P < .01). No differences were found for reintervention (P = .7), bleeding (P = .2), embolism (P = .3), or valve-related mortality (P = .8). Conclusions: Five years postoperatively, major adverse valve-related events and valve-related morbidity were more frequent after AVS than after AVR procedures, primarily because of more frequent aortic valve dysfunction. No between-group differences were found in rates of survival, valve-related mortality, reintervention on the aortic valve, or bleeding. We plan to follow this homogenous cohort for 20 years after aortic root replacement.
AB - Objective: The objective of this study was to compare midterm outcomes of aortic valve-replacing root replacement (AVR) and aortic valve-sparing root replacement (AVS) operations in patients with Marfan syndrome. Methods: Patients who met strict Ghent diagnostic criteria for Marfan syndrome and who underwent either AVR or AVS between March 1, 2005 and December 31, 2010 were enrolled in a 3-year follow-up prospective, multicenter, international registry study; the study was subsequently amended to include 20-year follow-up. Enrollees were followed clinically and echocardiographically. Results: Of the 316 patients enrolled, 77 underwent AVR and 239 underwent AVS; 214 gave reconsent for 20-year follow-up. The median clinical follow-up time for surviving patients was 64 months (interquartile range, 42-66 months). Survival rates for the AVR and AVS groups were similar at 88.2% ± 4.4% and 95.0% ± 1.5%, respectively (P = .1). Propensity score-adjusted competing risk modeling showed associations between AVS and higher cumulative incidences of major adverse valve-related events, valve-related morbidity, combined structural valve deterioration and nonstructural valve dysfunction, and aortic regurgitation ≥2+ (all P < .01). No differences were found for reintervention (P = .7), bleeding (P = .2), embolism (P = .3), or valve-related mortality (P = .8). Conclusions: Five years postoperatively, major adverse valve-related events and valve-related morbidity were more frequent after AVS than after AVR procedures, primarily because of more frequent aortic valve dysfunction. No between-group differences were found in rates of survival, valve-related mortality, reintervention on the aortic valve, or bleeding. We plan to follow this homogenous cohort for 20 years after aortic root replacement.
KW - Marfan syndrome
KW - aortic root replacement
KW - aortic valve regurgitation
KW - aortic valve replacement procedure
KW - aortic valve-sparing procedure
KW - outcomes
KW - valve-related complications
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UR - http://www.scopus.com/inward/citedby.url?scp=85115623647&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2021.08.064
DO - 10.1016/j.jtcvs.2021.08.064
M3 - Article
C2 - 34629178
AN - SCOPUS:85115623647
SN - 0022-5223
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
ER -