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| Long-term Results of Aortic Valve Sparing Operations in Patients with Marfan Syndrome | |
Tirone E. David, Susan Armstrong, Manjula Maganti, Jack Colman, Timothy Bradley; Cardiovascular Surgery, Toronto General Hospital, Toronto, ON, Canada
Methods: From 1988 to 2006, 103 consecutive patients with Marfan syndrome (mean age 37±12 years, 72% men) with aortic root aneurysm had aortic valve sparing operations. Emergency surgery was performed in 11 patients: 8 for acute type A dissection and 3 for unexplained persistent chest pain. Three patients had chronic type A dissection and previous ascending aorta replacement. Fifteen patients had moderate or severe aortic insufficiency (AI) and 14 had mitral insufficiency. Reimplantation of the aortic valve was performed in 77 patients and remodeling of the aortic root in 26. Patients were followed prospectively and had annual echocardiographic studies. The mean follow-up was 7.3±4.2 years, and 100% complete. Results: There was one operative death and 5 late deaths, 4 due to complications of aortic dissections. Patients’ survival at 15 years was 87.2% and that of the general of population matched for age and gender was 95.6%. Three patients required aortic valve replacement: 2 for AI and one for endocarditis. The freedom from reoperation on the aortic valve at 15 years was 87.6±7.7%. The latest echocardiographic study before death or reoperation showed no AI in 33 patients, trivial in 35, mild in 27, mild to moderate in 4, moderate in 2, and severe in 1. The freedom from AI of mild to moderate or greater grade at 5-, 10- and 15-year was 100%, 94.5±5.4%, and 88.2±11.7% respectively. Remodeling of the aortic root was not an independent predictor of AI. At the most recent follow-up 97 patients were alive: 86 were in functional class I and 11 in class II. Conclusion: Aortic valve sparing operations provide excellent long-term valve function and low rates of valve-related complications in patients with Marfan syndrome. Complications of aortic dissections remain problematic in these patients. Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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