Document Detail


Surgical management of the aortic root in patients with Marfan syndrome.
MedLine Citation:
PMID:  15700446     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM OF THE STUDY: Surgical aortic root reconstruction techniques are standard therapy to avoid catastrophic vascular events in patients with Marfan syndrome with a dilated and/or dissected aortic root. The study aim was to evaluate the long-term results of aortic root reconstruction. METHODS: Eighty-three patients (54 males, 29 females; mean age 37+/-17 years) fulfilling strict Ghent criteria for Marfan syndrome underwent aortic root surgery between 1971 and 2001. Of these patients, 65 (78%) underwent a composite valve conduit repair and 18 (22%) a valve-sparing aortic root reconstruction. Six patients (7%) suffered from an acute type A dissection, and 16 (19%) a chronic type A dissection. RESULTS: In-hospital and 30-day mortality was 3.6% (n = 3). Morbidity included stroke (1.2%; n = 1), perioperative myocardial infarction (1.2%; n = 1) and reoperation for bleeding (10%; n = 8). Of 21 late deaths, the cause was cardiac in nine cases. Actuarial survival at 5, 10, 15 and 20 years was 84% (95% CI 76-93%), 73% (CI 61-86%), 59% (CI 45-77%) and 43% (CI 26-72%), respectively. Multivariate predictors for late death were postoperative dysrhythmias and need for inotropes (p < or =0.01). Freedom from reoperation at 5, 10, 15 and 20 years was 86% (CI 78-95%), 69% (CI 56-85%), 53% (CI 38-74%) and 48% (CI 23-71%), respectively. Multivariate predictors for reoperation were preoperative mitral valve prolapse and an initial valve-sparing aortic procedure (p < or =0.05). In the composite valve conduit patients, freedom from thromboembolism was 88% (CI 76-100%), and from endocarditis was 99% (CI 93-100%) at 15 years. CONCLUSION: Composite valve conduit replacement of the aortic root in patients with Marfan syndrome offers a durable result, with low mortality and long-term complication rates. Reoperation was most commonly required for cardiac and vascular disease unrelated to the initial operation and in patients undergoing a valve-sparing aortic root procedure.
Authors:
Kenton J Zehr; Alireza Matloobi; Heidi M Connolly; Thomas A Orszulak; Francisco J Puga; Hartzell V Schaff
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  14     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2005-02-09     Completed Date:  2005-05-10     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  121-8; discussion 128-9     Citation Subset:  IM    
Affiliation:
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA. zehr.kenton@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aneurysm, Dissecting / surgery*
Aortic Aneurysm / surgery*
Aortic Valve / surgery*
Arrhythmias, Cardiac / complications
Cardiotonic Agents / therapeutic use
Female
Follow-Up Studies
Heart Valve Prosthesis
Hospital Mortality
Humans
Male
Marfan Syndrome / mortality,  surgery*
Mitral Valve Prolapse / complications
Multivariate Analysis
Postoperative Complications
Reoperation / statistics & numerical data
Retrospective Studies
Survival Analysis
Transplantation, Homologous
Chemical
Reg. No./Substance:
0/Cardiotonic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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