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J Thorac Cardiovasc Surg 2003;125:773-778
© 2003 The American Association for Thoracic Surgery

Editorials

Valve-sparing aortic root replacement in patients with the Marfan syndrome

From the Department of Cardiovascular Surgery, Stanford University School of Medicine, Stanford, Calif.

Received for publication Sept 7, 2002. Revisions requested Sept 17, 2002; revisions received Sept 23, 2002. Accepted for publication Oct 3, 2002. Address for reprints: D. Craig Miller, MD, Department of Cardiovascular Surgery, Stanford University School of Medicine, Falk Cardiovascular Research Center CV 243, 300 Pasteur Dr, Stanford, CA 94305-5407 (E-mail: dcm@stanford.edu).

The first 300 words of the full text of this article appear below.

	Introduction

 
See related article on page 789.

Your Editor solicited commentary for this provocative article, ¹ not so much to enter the fray concerning which method of valve-sparing aortic root replacement—Yacoub remodeling versus David reimplantation—is best for patients with the Marfan syndrome (MFS), but to clarify for the readership the key differences between the two procedures and how these operations have evolved. I will also emphasize six points raised by the article.

Historically, conventional cardiovascular surgical treatment for patients with the MFS who have aneurysm or dissection involving the ascending aorta has been replacement of the entire aortic root and valve with a composite valve graft (CVG) and reimplantation of the coronary artery ostia. A CVG incorporating a mechanical valve is usually used because most of these patients are young, can safely tolerate anticoagulation with warfarin, and do not wish to accept the risk of another operation. Over the past 30 years, CVG has become a low risk operation and a very durable one for patients with the MFS. ^2-4 On the other hand, some patients have medical contraindications that make indefinite anticoagulation inadvisable, others are not medically compliant enough for anticoagulation to be safe, some individuals have lifestyles that make anticoagulation hazardous, others do not have secure long-term access to health insurance or continuing medical care, some have an aversion to anticoagulation, and the older patients do not need a new valve that will last for many decades. In these relatively infrequent circumstances, the aortic root and valve can be replaced with an allograft aortic root, a stentless porcine xenograft aortic root, or a Dacron tube graft with a stented bioprosthesis sewn into it. ⁴ A Ross-Shumway procedure is contraindicated because of the aneurysmal disease and underlying connective tissue disorder. The durability of all these various tissue valve alternatives, however, is limited. . . . [Full Text of this Article]

Related Article

Results of surgery for aortic root aneurysm in patients with Marfan syndrome

Nilto Carias de Oliveira, Tirone E. David, Joan Ivanov, Susan Armstrong, Maria J. Eriksson, Harry Rakowski, and Gary Webb
J. Thorac. Cardiovasc. Surg. 2003 125: 789-796. [Abstract] [Full Text] [PDF]