164 * DECISION-MAKING IN AORTIC ROOT SURGERY IN MARFAN SYNDROME: BLEEDING, THROMBOEMBOLISM AND RISK OF REINTERVENTION AFTER VALVE-SPARING OR MECHANICAL AORTIC ROOT REPLACEMENT

Abstract

Objectives: Valve-sparing root replacement (VSRR) is thought to reduce the rate of thromboembolic and bleeding events compared to mechanical root replacement (MRR) by avoiding oral anticoagulation. But as VSRR carries a certain risk for subsequent reinterventions, decision-making in the individual patient can be challenging. Methods: Out of 100 Marfan syndrome patients that underwent 169 aortic surgeries and were followed at our institution since 1995, 60 patients without history of dissection or prior aortic surgery underwent elective VSRR or MRR and were retrospectively analysed. Results: VSRR was performed in 29 (David, n = 24 Yacoub, n = 5) and MRR in 31 patients. Mean age was 33 ± 15 years. Mean follow-up after VSRR was 6.5 ± 4 years (180 patient-years) compared to 8.8 ± 9 years (274 patient-years) after MRR. Reoperation rates after the remodelling (Yacoub) procedure were significantly higher than after the reimplantation (David) procedure (60% vs 4.2%, P = 0.01). The need for reinterventions after the reimplantation procedure (0.8% per patient-year) was not significantly higher than after MRR (P = 0.44), but follow-up after VSRR was significantly shorter (P = 0.03). There was neither significant morbidity nor mortality associated with root reoperations. There were no neurologic events after VSRR compared to 4 stroke/intracranial bleeding events in the MRR group (log-rank, P = 0.11), translating into an event rate of 1.46% per patient-year following MRR. Conclusion: The calculated annual failure rate after VSRR using the reimplantation technique was lower than the annual risk for thromboembolic or bleeding events. As the perioperative risk of reinterventions after VSRR itself is low, patients might benefit from VSRR even if they have to undergo redo surgery during follow-up.