Improved Outcomes Following Reimplantation of the Aortic Valve Compared to Remodeling in Marfan Syndrome: A Propensity-matched Study

Abstract

Objective: We sought to compare perioperative and late outcomes of patients with Marfan syndrome undergoing aortic valve sparing (AVS) root replacement using the reimplantation versus the remodeling technique. Methods: From 1988 to 2018, 194 patients with Marfan syndrome underwent AVS procedures in a single center. Of these, 24 who had remodeling AVS were matched to 44 who had reimplantation (1:2 matching). After matching, baseline characteristics were well balanced including: age, sex, NYHA III/IV, moderate or severe AI, acute aortic dissection, and year of operation. Outcomes included perioperative mortality and complications, as well as late survival, freedom from reoperation on the aortic valve, and probability of developing moderate or severe AI. Results: There was no in-hospital mortality, stroke, sepsis, myocardial infarction, or need for permanent pacemaker. Re-exploration was slightly lower in reimplantation patients (n=1 2% vs n=3 12% p=0.04) ICU length of stay was 2±1 day and similar between groups. Median follow up was 17.5 years (IQR: 11.8 - 20.4). Survival at 20 years was not different following remodeling vs reimplantation (71% vs 80% p=0.36). However, 20-year moderate to severe aortic insufficiency and reoperation were higher in remodeling patients (31% vs 16% p=0.01; and 18% vs 0% p=0.01). Conclusions: AVS operations have excellent long term survival and durability in Marfan syndrome. Reimplantation was associated with less early re-exploration and lower risk of late aortic insufficiency and reintervention at 20 years.