Francesco Nicolo1,4, Francesco Romeo3, Antonio Lio1, Emanuele Bovio1, Antonio Scafuri1, Carlo Bassano1, Patrizio Polisca1, Antonio Pellegrino1, Paolo Nardi1, Luigi Chiariello2, Giovanni Ruvolo11Cardiac Surgery Unit and Marfan Center, Tor Vergata University Policlinic, Rome, Italy
2Cardiac Surgery Unit, Clinica Mediterranea, Naples, Italy,
3Department of Cardiovascular Disease, Tor Vergata University Policlinic, Rome, Italy
4Electronic correspondence: firstname.lastname@example.org
Background and aim of the study: The study aim was to compare long-term results of Marfan syndrome (MFS) patients affected by aortic root disease undergoing aortic root replacement with the Bentall or David operation.
Methods: Since 1994, a total of 59 patients has been followed at the authors’ Marfan Center, having undergone either a Bentall operation (Bentall group, n = 30) or a David operation (David group, n = 29).
Results: No operative mortality was recorded. After 20 years (mean follow up 97 ± 82 months; range 1 to 369 months) no prosthesis-related major bleeding or thromboembolic events had been observed; the 20-year survival was 94 ± 6% in the Bentall group, and 100% in the David group (p = 0.32). Freedom from reintervention for aortic valve dysfunction was 100% in the Bentall group, and 75 ± 13% in the David group (p = 0.04). This inter-group difference became relevant after the first eight-year
period of follow-up, and was mainly associated with a particular familiar genetic phenotype involving three out of four reoperated patients. Freedom from all-cause death, myocardial infarction, stroke, prosthetic valve-related complications, and reintervention on any aortic segment was 69 ± 12% in the Bentall group, and 67 ± 14% in the David group (p = 0.33).
Conclusion: The Bentall and David operations are both associated with satisfactory long-term results in MFS patients. The low rate of valve prosthesis-related complications suggested that the Bentall operation would continue to be a standard surgical treatment. The reimplantation technique, adopted for less-dilated aortas, provides satisfactory freedom from reoperation. Careful attention should be paid to the reimplantation technique in patients affected by a serious familiar genetic phenotype.
The Journal of Heart Valve Disease 2017;26:397-404
|Long-Term Results of Aortic Root Surgery in Marfan Syndrome Patients: A Single-Center Experience|
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