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J Thorac Cardiovasc Surg 2003;125:789-796
© 2003 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
From the Divisions of Cardiovascular Surgery and Cardiology of Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
Read at the Eighty-second Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 5-8, 2002.
Received for publication May 5, 2002. Revisions requested Aug 1, 2002; revisions received Aug 9, 2002. Accepted for publication Aug 15, 2002. Address for reprints: Tirone E. David, MD, 200 Elizabeth St, 13EN-219, Toronto, Ontario, Canada M5G 2C4 (E-mail: tirone.david{at}uhn.on.ca).
Objectives: This study was undertaken to examine the long-term results of surgery for aortic root aneurysm in patients with Marfan syndrome.
Methods: Forty-four patients underwent aortic root replacement and 61 underwent aortic valve-sparing operations for aortic root aneurysm. Patients who underwent aortic root replacement had more severe symptoms, worse left ventricular function, more severe aortic insufficiency, and larger aortic root aneurysms than did patients who had aortic valve-sparing operations. Two types of valve-sparing operations were performed: reimplantation of the aortic valve in 39 patients and remodeling of the aortic root in 22 patients. Echocardiography was performed annually during follow-up. The mean follow-ups were 75 ± 54 months for the aortic root replacement group and 49 ± 38 months for the aortic valve-sparing group.
Results: There were 1 early death and 7 late deaths; 6 deaths were in the aortic root replacement group and 2 were in the aortic valve-sparing group. Survivals at 10 years were 87% in the aortic root replacement group and 96% in the aortic valve-sparing group (P = .3). Freedoms from reoperation at 10 years were 75% in the root replacement group and 100% in the valve-sparing group (P = .1). Freedoms from valve-related mortality and morbidity were 65% after root replacement and 100% after valve-sparing operation (P = .02). Freedom from aortic insufficiency greater than 2+ after aortic valve-sparing operations was 75% at 10 years and was similar for both types of valve-sparing operations; however, the diameters of the aortic annulus and neoaortic sinuses increased only after the remodeling procedure.
Conclusions: This study suggests that aortic valve-sparing operations provide similar survival but lower rates of valve-related complications than aortic root replacement for patients with Marfan syndrome. Reimplantation of the aortic valve may be more appropriate than remodeling of the aortic root to prevent dilation of the aortic annulus, and for this reason we now use only this technique to treat patients with Marfan syndrome.
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J. Thorac. Cardiovasc. Surg. 2003 125: 773-778.
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