Objectives: Aortic complications are the most common causes of death in patients with Marfan syndrome. Valve-sparing aortic root surgery in the presence of ascending aortic aneurysm has shown good mid- and long-term stability. The purpose of this study was to summarize our experience of more than 20 years.
Methods: From 11/1996 to 07/2016, 61 patients with Marfan syndrome were operated by valve-sparing aortic root replacement. The majority underwent root remodeling (n = 49, 80.3%), in 12 patients (19.7%) aortic valve reimplantation was performed. Since 2009 a suture annuloplasty for correction of annular dilatation was added to root remodeling (n = 34, 69.4%). The primary indication for surgery was ascending aortic aneurysm (n = 54, 88.5%) or acute aortic dissection (n = 7, 11.5%). Valve anatomy was either bicuspid (n = 5, 8.2%) or tricuspid (n = 56, 91.8%), preoperative aortic regurgitation (AR) varied from trace to severe. All patients were followed, follow-up was complete in 98.4% with a mean of 95 ± 64 months.
Results: Three patients died during follow-up (5.1%), survival at 15 years was 90.8%. Four patients required reoperation on the aortic valve, freedom from reoperation was 98.2% at 5 years and 85.0% at 10 and 15 years. Valve reimplantation led to slightly inferior freedom from reoperation at 10 and 15 years (71.6%) compared with root remodeling at 10 years (95.8%; p = 0.11). Since the introduction of suture annuloplasty no patient required reoperation. Freedom from moderate AR at 5 years is 90.7% and 77.7% at 10 and 15 years. At 10 and 15 years it was 72.7% after valve reimplantation and 77.3% at 10 years after root remodeling (p = 0.55).
Conclusions: Valve-preserving aortic replacement in patients with Marfan syndrome leads to good stability in mid- and long-term follow-up. Reoperations are rare and valve function remains stable in the majority of patients. Valve reimplantation and root remodeling lead to comparable results over time. With the addition of suture annuloplasty to root remodeling the need for reoperation could be minimized.
