External aortic root support for Marfan syndrome

Abstract

We have read the interesting article by Pepper and colleagues1 about their experience on the external support of the aortic root in Marfan syndrome. This is a good contribution to the expanding literature about Marfan syndrome; however, there are few facts that should be clarified. First of all, 66 patients have been removed from the analysis for the comparison of the groups due to previous operations or re-operations. Why? Re-operation in the Marfan patients is an important fact that should be kept in mind in planning the operation. As we have reported before,2 about 20% of our patients had ≥1 re-operations due to dilatations in the other segments of the aorta or mitral valve problems. Second, the follow-up data of the 20 patients are unclear. There is a figure of aortic dimensions but the time of the last postoperative examination from the time of the operation is unclear. In our report of the long-term results of the aortic root operations, Marfan syndrome was found to be associated with decreased long-term survival.3 Third, as the authors have stated, the aneurysm does not necessarily precedes aortic dissection in Marfan patients. That is why; the operation indication is lower than that of the normal population.4 In order to take advantage of refraining from the use of anticoagulation, is it wise to take the risk of an aortic dissection in this segment? We have used similar external support for an abdominal aneurysm in one of our patients in a re-operation2 in order to decrease the operation risk. However, a young population like this mandates a more definitive treatment in our point of view. We would like to thank the authors for their study and would like to hear their contributions to the discussion.