Results of surgery for aortic root aneurysm in patients with the Marfan syndrome

Objective: To evaluate the results of two operations, aortic valve-sparing and aortic root replacement, in patients with aortic root aneurysm and the Marfan syndrome. Methods: A retrospective review of 78 consecutive patients with aortic root aneurysm and the Marfan syndrome according to the Gent cr iteria indicated that 42 patients with normal aortic cusps had an aortic va lve-sparing operation, and 36 patients had aortic root replacement (mechani cal valve in 25 patients and biological valve in ii). The mean age was simi lar in both groups, but patients who had aortic root replacement had larger aneurysms, higher grade aortic insufficiency, worse left ventricular funct ion and more cardiac co-morbidity than patients who had aortic valve-sparin g operations. The mean follow-up was 41 +/- 35 months for patients who had aortic valve-sparing, and 65 +/- 50 months for those who had aortic root re placement. Results: Kaplan-Meyer estimates of survival at 5 years was 100% for patients who had aortic valve-sparing, and 88 +/- 6% for those who had aortic root replacement (P = 0.04). Five patients who had aortic root repla cement required seven aortic root re-replacements: three for endocarditis a nd four for valve failure (biological valves). There have been no reoperati ons in patients who had aortic valve-sparing operations and annual Doppler echocardiography revealed mild or no aortic insufficiency in 39 patients an d moderate aortic insufficiency in three. Conclusions: These data suggest t hat aortic valve-sparing operations are safe in patients with the Marfan sy ndrome and may provide better clinical outcomes than aortic root replacemen t. Since the size of the aneurysm often determines the feasibility of a val ve-sparing procedure, we now recommend surgery when the diameter of the aor tic root reaches 50 mm in patients with the Marfan syndrome who have echoca rdiographically normal aortic valve cusps. (C) 2000 Elsevier Science B.V. A ll rights reserved.