Joao Lima

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Aortic root replacement in 271 Marfan patients: a 24-year experience.

Vincent L Gott; Duke E Cameron; Diane E Alejo; Peter S Greene; Jay G Shake; David J Caparrelli; Harry C Dietz (Profiled Authors: Duke Cameron; Vincent Gott; Harry Dietz; Peter Greene)

Division of Cardiac Surgery, the Institute of Genetic Medicine and the Howard Hughes Medical Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. vgott@csurg.jhmi.jhu.edu
The Annals of thoracic surgery 2002;73(2):438-43.

BACKGROUND: The introduction of composite graft repair of aortic root aneurysm by Hugh Bentall in 1968 promised Marfan patients the choice for a normal life expectancy. We performed our first Bentall composite graft procedure in 1976 and herein report our 24-year experience with 271 Marfan patients. METHODS: Between September 1976 and August 2000, 232 Marfan patients had a composite graft replacement of the aortic root, 15 patients received a homograft, and 24 had a valve-sparing procedure. RESULTS: Two hundred thirty-five Marfan patients underwent elective aortic root replacement with no 30-day mortality. Two early deaths occurred among 36 patients who underwent urgent or emergent operation. Eighty-three percent of patients in this series are currently alive. The actuarial freedom from thromboembolism, endocarditis, and reoperation on the residual aorta 20 years postoperatively was 93%, 90%, and 74%. Twenty-four patients have undergone valve-sparing procedures with encouraging results. CONCLUSIONS: Elective aortic root replacement for Marfan patients can be performed with low operative risk. Elective repair before the aortic root reaches 6 cm in diameter is recommended to minimize risk of dissection and rupture.

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