Thorac Cardiovasc Surg 2010; 58(2): 76-80
DOI: 10.1055/s-0029-1186277
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Valve-Sparing Operation for Aortic Root Aneurysm in Patients with Marfan Syndrome

R. Wang1 , W. G. Ma1 , L. X. Tian1 , L. Z. Sun1 , Q. Chang1
  • 1Department of Cardiovascular Surgery, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Further Information

Publication History

received July 24, 2009

Publication Date:
23 March 2010 (online)

Abstract

Background: We report our experience with aortic valve-sparing procedures in patients with Marfan syndrome and aortic root aneurysm. Methods: Between August 2003 and July 2007, we performed aortic valve-sparing procedures in 20 patients with aortic root aneurysm resulting from Marfan syndrome. Mean age was 28 ± 10 years (range, 10 to 57 years), and there were 9 females and 11 males. A reimplantation technique was used in 9 cases, a remodeling technique in 8 and a patch technique in 3 cases. Additional procedures included total aorta replacement in 1 patient, and aortic arch replacement plus stented elephant trunk in 2 patients. The mean follow-up time was 46 ± 16 months (range, 17 to 64 months). Results: No in-hospital or late death occurred. Reexploration for bleeding was required in one case on postoperative day 1. No valve-related complications occurred during the follow-up period. At the end of follow-up, trivial or no aortic regurgitation was demonstrated in 14 patients, mild in 4 patients, moderate in 1 and severe in 1. Two patients with moderate and severe aortic regurgitation required reoperation. Conclusions: The early and mid-term results of the valve-sparing operations were favorable, and the durability of the preserved valve should encourage use of this technique in patients with Marfan syndrome.

References

  • 1 Bentall H, De Bono A. A technique for complete replacement of the ascending aorta.  Thorax. 1968;  23 338-339
  • 2 Yacoub M H, Fagan A, Stessano P, Radley-Smith R. Results of valve conserving operations for aortic regurgitation.  Circulation. 1983;  68 311
  • 3 David T E, Feindel C M. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta.  J Thorac Cardiovasc Surg. 1992;  103 617-621
  • 4 De Paepe A, Devereux R B, Dietz H C, Hennekam R C, Pyeritz R E. Revised diagnostic criteria for the Marfan syndrome.  Am J Med Genet. 1996;  62 417-426
  • 5 Liu Z G, Sun L Z, Chang Q et al. Should the “elephant trunk” be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection.  J Thorac Cardiovasc Surg. 2006;  131 107-113
  • 6 Hu X P, Chang Q, Zhu J M, Yu C T, Liu Z G, Sun L Z. One-stage total or subtotal aortic replacement.  Ann Thorac Surg. 2006;  82 542-547
  • 7 Urbanski P P. Valve-sparing aortic root repair with patch technique.  Ann Thorac Surg. 2005;  80 839-844
  • 8 Edmunds Jr L H, Clark R E, Cohn L H, Grunkemeier G L, Miller D C, Weisel R D. Guidelines for reporting morbidity and mortality after cardiac valvular operations.  Ann Thorac Surg. 1996;  62 932-935
  • 9 Dietz H C, Cutting G R, Pyeritz R E. Marfan syndrome caused by a recurrent de novo missense mutation in the fibrillin gene.  Nature. 1991;  352 337-339
  • 10 Murdoch J L, Walker B A, Halpern B L, Kuzma J W, McKusick V A. Life expectancy and causes of death in the Marfan syndrome.  N Engl J Med. 1972;  286 804-808
  • 11 Gott V L, Greene P S, Alejo D E et al. Replacement of the aortic root in patients with Marfan's syndrome.  N Engl J Med. 1999;  340 1307-1313
  • 12 Griepp R B, Lytle B W, David T E et al. Aortic surgery symposium VIII. Discussion; session 1: ascending aorta.  Ann Thorac Surg. 2002;  74 S1792-S1799
  • 13 David T E, Ivanov J, Amstrong S, Feindel C, Webb G. Aortic valve sparing operations in patients with aneurysms of the aortic root or ascending aorta.  Ann Thorac Surg. 2002;  74 S1758-S1761
  • 14 Birks E J, Webb C, Child A, Radley-Smith R, Yacoub M H. Early and long-term results of a valve-sparing operation for Marfan syndrome.  Circulation. 1999;  100 II-29-II-35
  • 15 Patel N D, Weiss E S, Alejo D E et al. Aortic root operations for Marfan syndrome: a comparison of the Bentall and valve-sparing procedures.  Ann Thorac Surg. 2008;  85 2003-2011
  • 16 Yousif B S, Sheinfield A, Tager S et al. Aortic root surgery in Marfan syndrome.  IMAJ. 2008;  10 189-193
  • 17 de Oliveira N C, David T E, Ivanov J et al. Results of surgery for aortic root aneurysm in patients with Marfan syndrome.  J Thorac Cardiovasc Surg. 2003;  125 789-796
  • 18 David T E. Aortic valve sparing for aortic root aneurysm in patients with Marfan syndrome.  Rev Esp Cardiol. 2007;  60 461-463
  • 19 Brooke B S, Habashi J P, Judge D P, Patel N, Loeys B, Dietz III H C. Angiotensin II blockade and aortic-root dilation in Marfan's syndrome.  N Engl J Med. 2008;  358 2787-2795
  • 20 Habashi J P, Judge D P, Holm T M et al. Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of Marfan syndrome.  Science. 2006;  312 117-121

Dr. Lizhong Sun, MD

Department of Cardiovascular Surgery
Cardiovascular Institute and Fu Wai Hospital
Chinese Academy of Medical Sciences and Peking Union Medical College

167 Belishi Road

100037 Beijing

China

Phone: + 86 10 88 39 89 37

Fax: + 86 10 68 31 31 02

Email: slzh_2005@yahoo.com.cn

    >