Aortic Valve–Sparing Operation in Marfan Syndrome: What Do We Know After a Decade?

Background We assessed the outcome in patients with Marfan syndrome operated on exclusively with the aortic valve–sparing reimplantation technique for aortic root aneurysms during more than a decade. Methods Between July 1993 and April 2005, the aortic valve–sparing reimplantation technique (David I) was used in 325 patients. In 59 patients with clinical evidence of Marfan syndrome, procedures were done for aortic root aneurysm (n = 55) or aortic dissection type A (n = 4). Their mean age was 30 ± 12 years (range, 9 to 62 years), and 37 (63%) were male. Additional procedures were arch replacement in 4 patients, coronary artery bypass grafting in 1, mitral valve surgery in 9, and closure of atrial septal defect in 3. Mean follow-up was 54 ± 37 months (range, 0 to 139 months). Results No patient died during the first 30 days postoperatively. Mean bypass time was 163 ± 34 minutes (range, 99 to 248 minutes), and mean aortic cross clamp time was 126 ± 28 minutes (range, 78 to 202 minutes). Four patients (6.8%) required rethoracotomy for postoperative bleeding. Five late deaths (8.5%) occurred during follow-up. Reoperation of the reconstructed valve was required in 7 patients. Freedom from reoperation was 88% ± 5% at 5 years and 80% ± 9% at 10 years. Mean grade of aortic insufficiency was 1.81 preoperatively compared with 0.20 early postoperatively (p < 0.001). At last investigation, the mean grade of aortic insufficiency increased slightly to 0.22 (p = 0.16). Anticoagulation was not required in 67% of patients. One thromboembolic complication and four instances of minor bleeding were documented. All patients were in New York Heart Association functional class I (86%) or II at last contact. Conclusions Excellent early outcome, favorable long-term results, and acceptable durability of the reimplanted valve should encourage use of this technique in patients with Marfan syndrome.