SURGICAL IMPLICATION OF AORTIC DISSECTION ON LONG-TERM OUTCOME IN MARFAN PATIENTS

We herein review our 17-year surgical experience for the treatment of ascending aortic aneurysm in patients with Marfan syndrome to clarify the risks of increased mortality and reoperation, The subjects consist ed of 15 patients who had all undergone surgery for the aortic root an d ascending aorta at Niigata University Hospital between July 1978 and January 1995, Aortic valve replacement and ascending aortic wrapping were performed in 5 patients, Bentall or Cabrol operation in 6, and co mbined aortic arch reconstruction and Cabrol operation in 2, as the in itial surgery, Patients who had an aortic dissection (Stanford type A) at initial surgery were assigned to group I (n = 7), while those with an aortic root aneurysm were assigned to group II (n = 8), In group I , 3 patients required a second operation for the remaining aortic arch aneurysm, and 1 died due to a late rupture of the distal aneurysm, In group II, no patient needed a reoperation: however, 1 died due to an intracranial hemorrhage and another due to composite valve graft failu re and distal dissection, The results thus indicate that aortic dissec tion seems to affect longterm outcome, and therefore the combined repa ir of the aortic root and transverse arch is recommended in Marfan pat ients with aortic dissection involving the transverse aortic arch.