Abstract
Valve-sparing aortic root replacement (VSARR) through reimplantation technique is widely regarded as optimal surgical approach for Marfan syndrome (MFS) patients. Perioperative and long-term data from all MFS patients undergoing VSARR using David’s technique at our center from 2007–2018 were analyzed. We included 56 patients with a mean age of 32.3 ± 12.3 years. Logistic EuroSCORE was 7.96 ± 5.2. Among others concomitant surgical procedures included aortic arch surgery (8.9%), mitral valve repair (23.2%) and replacement (1.7%). There were no operative deaths, nor in-hospital-mortality. One patient underwent re-exploration for bleeding, dialysis and pacemaker implantation was required in one case each. There was no occurrence of low-output syndrome nor neurological complications. Significant gender differences were not found, except for intraoperative blood transfusion occurring significantly more often in the female gender (p = 0.009). Despite significantly longer procedural times, concomitant surgery did not negatively impact overall outcome. Freedom of reoperation of the aortic root was 100% at 1 year, 97.7% at 8 years. Until last follow-up (61 ± 38 month) all patients survived, with no evidence of endocarditis. We emphasize once more that VSARR using David’s procedure is a safe method for MFS patients with excellent long-term results even if concomitant procedures are performed.
Highlights
Valve-sparing aortic root replacement (VSARR) through reimplantation technique is widely regarded as optimal surgical approach for Marfan syndrome (MFS) patients
In patients suffering from Marfan syndrome (MFS) the fibrillin-1 gene (FBN1) mutation is inherited autosomal dominant with considerable phenotypical variability
The aortic valve-sparing reimplantation technique first described by David and Feindel[3] was originally developed as an aortic valve-sparing operation for patients with aortic valve incompetence and aneurysm of the ascending aorta[4]
Summary
Valve-sparing aortic root replacement (VSARR) through reimplantation technique is widely regarded as optimal surgical approach for Marfan syndrome (MFS) patients. Among others concomitant surgical procedures included aortic arch surgery (8.9%), mitral valve repair (23.2%) and replacement (1.7%). We emphasize once more that VSARR using David’s procedure is a safe method for MFS patients with excellent long-term results even if concomitant procedures are performed. Prophylactic replacement of the dilated aortic root with preservation of the native aortic valve leads to excellent results, allowing an almost normal life-expectancy, avoiding the need of lifelong anticoagulation, especially for younger patients with MFS5–8. Our study assesses outcome in patients with MFS operated on exclusively using the aortic valve-sparing reimplantation technique for aortic root aneurysms during more than a decade at a single center
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