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J Thorac Cardiovasc Surg 2004;127:391-398
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Aortic root surgery in Marfan syndrome: Comparison of aortic valve-sparing reimplantation versus composite grafting

^a Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany

Read at the Eighty-third Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 4-7, 2003.

Received for publication May 3, 2003; revisions received July 15, 2003; accepted for publication July 30, 2003.

^* Address for reprints: Matthias Karck, MD, Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, 30623 Hannover, Germany
Karck{at}thg.mh-hannover.de

OBJECTIVE: The objective of this study was to compare the results of aortic valve-sparing reimplantation and aortic root replacement with mechanical valve conduits in patients with Marfan syndrome undergoing operation for aortic root aneurysms.

PATIENTS AND METHODS: Between March 1979 and April 2002, 119 patients with clinical evidence of Marfan syndrome underwent composite graft replacement with mechanical valve conduits (n = 74) or aortic valve-sparing reimplantation according to David (n = 45). The underlying causes were aortic dissection type A (43 patients) and aneurysms (76 patients).

RESULTS: Patients undergoing aortic valve reimplantation were younger compared with patients undergoing composite grafting (28 vs 35 years, P = .002) and had longer intraoperative aortic crossclamp times (125 vs 78 minutes, P < .0001) and extracorporeal circulation times (162 vs 124 minutes, P < .0001). Early postoperative mortality was 6.8% (n = 5) in patients undergoing composite grafting and 0% in patients undergoing aortic valve reimplantation (P = .15). Mean follow-up was 30 months for patients undergoing aortic valve reimplantation and 114 months for patients undergoing composite grafting. Freedom from reoperation and death after 5 years postoperatively was 92% and 89% in patients undergoing composite grafting and 84% and 96% in patients undergoing aortic valve reimplantation (P = .31; P = .54), respectively. Thromboembolic complications or late postoperative bleeding occurred in 17 patients undergoing composite grafting, and an early postoperative event occurred in 1 patient undergoing aortic valve reimplantation.

CONCLUSIONS: The results of aortic valve reimplantation and composite grafting of the aortic valve and ascending aorta with mechanical valve conduits are similar with regard to early and mid-term postoperative mortality and to the incidence of late reoperations in patients with Marfan syndrome. The low risk of thromboembolic or bleeding complications favors aortic valve reimplantation in these patients.