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J Thorac Cardiovasc Surg 2009;137:641-649
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

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

Irina V. Volguina, PhDa,*, D. Craig Miller, MDb, Scott A. LeMaire, MDa, Laura C. Palmero, MPHa, Xing Li Wang, MD, PhDa, Heidi M. Connolly, MDc, Thoralf M. Sundt, III, MDc, Joseph E. Bavaria, MDd, Harry C. Dietz, MDe, Dianna M. Milewicz, MD, PhDf, Joseph S. Coselli, MDa Aortic Valve Operative Outcomes in Marfan Patients study group

a Baylor College of Medicine and the Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Tex
b Stanford University, Stanford, Calif
c Mayo Clinic, Rochester, Minn
d University of Pennsylvania, Philadelphia, PA
e Johns Hopkins Hospital, Baltimore, MD
f University of Texas Health Science Center, Houston, Tex

Received for publication May 6, 2008; revisions received October 9, 2008; accepted for publication November 15, 2008.

* Address for reprints: Irina V. Volguina, PhD, Baylor College of Medicine, Division of Cardiothoracic Surgery, One Baylor Plaza, BCM 390, Houston, TX 77030. (Email: volguina{at}bcm.edu).

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.

Abbreviations and Acronyms AVR = aortic valve-replacing; AVS = aortic valve-sparing; DCC = Data Coordination Center; MFS = Marfan syndrome


Related Article

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, III, Joseph E. Bavaria, Harry C. Dietz, Dianna M. Milewicz, Joseph S. Coselli Aortic Valve Operative Outcomes in Marfan Patients study group
J. Thorac. Cardiovasc. Surg. 2009 137: 1124-1132. [Abstract] [Full Text] [PDF]



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U. Benedetto, G. Melina, J. J. M. Takkenberg, A. Roscitano, E. Angeloni, and R. Sinatra
Surgical management of aortic root disease in Marfan syndrome: a systematic review and meta-analysis
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