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The Journal of Cardiovascular Surgery 1998 February;39(1):65-74

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Surgical treatment of Marfan patients with aneurysms and dissection of the proximal aorta

Mingke D., Dresler Ch., Pethig K., Heinemann M., Borst H. G.

From the Department of Cardiovascular and Thoracic Surgery Hannover Medical School Hannover, Germany


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Background. The ­authors ret­ro­spec­tively ana­lyzed ear­ly ­and ­late ­results of sur­gi­cal treat­ment ­for 79 Marfan ­patients ­with aneu­rysms ­and dis­sec­tion of ­the prox­i­mal aor­ta.
Methods. From September 1979 to February 1996, 79 ­patients ­with Marfan syn­drome under­went aor­tic ­root replace­ment ­using com­pos­ite ­grafts (n=68, Bentall-tech­nique 63, but­ton-tech­nique 5), ­and ascend­ing aor­tic replace­ment ­with a ­valve-spar­ing pro­ce­dure (n=11). There ­were 12 ­patients (15.2%) ­who simul­ta­ne­ous­ly ­received par­tial or ­total ­arch replace­ment. 55 ­patients (69.6%) ­were ­male, ­and 24 ­female (30.4%). The aver­age ­age ­was 33.8 ­years. Forty-­one ­patient (51.9%) ­had ­non-dis­sect­ing aneu­rysms ­while ­the remain­ing 38 ­patients suf­fered ­from ­either ­acute (24.0%) or chron­ic aor­tic dis­sec­tion (24.0%). The aor­tic ­valve ­was ­involved in 97.5% of ­all cas­es.
Results. The ­total ear­ly mor­tal­ity (≤30 ­days) ­was 3.8%, 10.5% ­for ­acute aor­tic dis­sec­tion ­and 2.4% ­for ­non-dis­sest­ing aneu­rysms. There ­were no ear­ly post­op­er­a­tive ­deaths in ­patients ­after ­valve-spar­ing oper­a­tion ­and in ­those ­with chron­ic aor­tic dis­sec­tion. The fol­low-up ­rate ­was 98.7%. During a ­mean fol­low-up of 68±25 ­months 10 ­patients (13.3%) ­died ­and car­diac com­pli­ca­tions ­were a com­mon ­cause of ­the ­late ­deaths. There ­was no ­late mor­tal­ity in ­the ­valve-spar­ing oper­a­tions dur­ing a ­mean fol­low-up peri­od of 8±6 ­months, how­ev­er, 1 ­required ­valve replace­ment. 19 (25.3%) of ­the 75 ­patients sur­viv­ing ­late ­have under­gone 25 sec­on­dary oper­a­tions on ­the car­di­o­vas­cu­lar ­system. Reoperations at aor­tic ­sites dis­tant ­from ­the orig­i­nal ­were ­much ­more fre­quent ­after pri­mary ­repair ­for ­acute ­and chron­ic dis­sec­tion ­when com­pared to ­non-dis­sect­ing aneu­rysms (p<0.005). Actuarial sur­vi­val ­rate of ­all ­patients ­with com­pos­ite ­graft replace­ment includ­ing ear­ly ­deaths ­was 91.2% at 1 ­year, 84.4% at 5 ­years ­and 75.2% at 10 ­years.
Conclusions. Composite ­graft inser­tion ­has ­become ­the ­gold stan­dard ­for treat­ing Marfan-­patients ­with ­non-dis­sect­ing ­and dis­sect­ing aneu­rysms of ­the aor­tic ­root. Our ear­ly expe­ri­ence in 11 ­patients ­with ­valve-spar­ing pro­ce­dures indi­cat­ed ­that ­this var­i­ant ­may be ­the bet­ter ­choice in select­ed ­patients.

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