Valve-sparing and valve-replacing techniques for aortic root replacement in patients with Marfan syndrome: Analysis of early outcome

Irina V. Volguina, D. Craig Miller, Scott A. LeMaire, Laura C. Palmero, Xing Li Wang, Heidi M. Connolly, Thoralf M. Sundt, Joseph E. Bavaria, Harry C. Dietz, Dianna M. Milewicz, Joseph S. Coselli

Research output: Contribution to journalArticle

Abstract

Objective: A prospective, international registry study was initiated to provide contemporary comparative data on short-term clinical outcomes after aortic valve-sparing and aortic valve-replacing root operations in patients with Marfan syndrome. The purpose of this initial report is to describe the study design and to compare early outcomes in the first 151 enrolled patients. Methods: We assessed 30-day outcomes in 151 patients who met strict Ghent diagnostic criteria for Marfan syndrome and underwent aortic root replacement with either valve-replacing (n = 46) or valve-sparing techniques (n = 105) at one of 18 participating centers. In the valve replacement group, a mechanical composite valve graft was used in 39 (85%) patients and a bioprosthetic valve in 7 (15%). In the valve-sparing group, David V procedures were performed in 57 (54%) patients, David I in 38 (36%), David IV in 8 (8%), Florida sleeve in 1 (1%), and Yacoub remodeling in 1 (1%). Results: No in-hospital or 30-day deaths occurred. Despite longer crossclamp and cardiopulmonary bypass times in the valve-sparing group, there were no significant between-group differences in postoperative complications. Thirty-day valve-related complications occurred in 2 (4%) patients undergoing valve replacement and in 3 (3%) undergoing valve-sparing procedures (P = .6). Conclusions: The analysis of early outcomes revealed that valve-sparing techniques were the most common approach to root replacement in patients with Marfan syndrome in these centers. The complexity of valve-sparing root replacement did not translate into any demonstrable adverse early outcomes. Subsequent analysis will compare the 3-year durability of these two surgical approaches.

Original languageEnglish (US)
Pages (from-to)1124-1132
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume137
Issue number5
DOIs
StatePublished - May 1 2009

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Volguina, I. V., Miller, D. C., LeMaire, S. A., Palmero, L. C., Wang, X. L., Connolly, H. M., Sundt, T. M., Bavaria, J. E., Dietz, H. C., Milewicz, D. M., & Coselli, J. S. (2009). Valve-sparing and valve-replacing techniques for aortic root replacement in patients with Marfan syndrome: Analysis of early outcome. Journal of Thoracic and Cardiovascular Surgery, 137(5), 1124-1132. https://doi.org/10.1016/j.jtcvs.2009.03.023