Boston - American Association for Thoracic Surgery

AMERICAN ASSOCIATION FOR THORACIC SURGERY3. Long-Term Results of Aortic Valve Sparing Operations in Patientswith Marfan SyndromeTirone E. David, * Susan Armstrong, Manjula Maganti, Jack Colman,Timothy BradleyCardiovascular Surgery, Toronto General Hospital, Toronto, ON, CanadaInvited Discussant: Lars G. SvenssonOBJECTIVE: This study examines the long-term results of aortic valve sparingoperations in patients with Marfan syndrome.METHODS: From 1988 to 2006, 103 consecutive patients with Marfan syndrome(mean age 37 ± 12 years, 72% men) with aortic root aneurysm had aortic valvesparing operations. Emergency surgery was performed in 11 patients: 8 for acutetype A dissection and 3 for unexplained persistent chest pain. Three patients hadchronic type A dissection and previous ascending aorta replacement. Fifteenpatients had moderate or severe aortic insufficiency (AI) and 14 had mitral insufficiency.Reimplantation of the aortic valve was performed in 77 patients and remodelingof the aortic root in 26. Patients were followed prospectively and had annualechocardiographic studies. The mean follow-up was 7.3 ± 4.2 years, and 100%complete.MONDAYMorningRESULTS: There was one operative death and 5 late deaths, 4 due to complicationsof aortic dissections. Patients’ survival at 15 years was 87.2% and that of thegeneral of population matched for age and gender was 95.6%. Three patientsrequired aortic valve replacement: 2 for AI and one for endocarditis. The freedomfrom reoperation on the aortic valve at 15 years was 87.6 ± 7.7%. The latest echocardiographicstudy before death or reoperation showed no AI in 33 patients, trivial in35, mild in 27, mild to moderate in 4, moderate in 2, and severe in 1. The freedomfrom AI of mild to moderate or greater grade at 5-, 10- and 15-year was 100%, 94.5± 5.4%, and 88.2 ±1 1.7% respectively. Remodeling of the aortic root was not anindependent 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 valvefunction and low rates of valve-related complications in patients with Marfan syndrome.Complications of aortic dissections remain problematic in these patients.* AATS Member73