Aortic repair in Marfan's syndrome: prevention of mechanical leaflets damage

Aortic incompetence in Marfan's syndrome results from distortion or dilatat ion of the sinuses of Valsalva, annuloaortic ectasia or a combination of th ese problems. Valve leaflets in these patients are macroscopically normal i n spite of aortic insufficiency. Replacement of the ascending aorta. root a nd aortic valve with a composite graft was, for a long time, the treatment of choice for Marfan patients. Valve-preserving procedures (remodeling or r eimplantation) provide the advantages of avoiding the shortcomings of stand ard surgical techniques. and maintaining the functional integrity of the le ft ventricular (LV) ouflow tract, aortic root and ascending aorta. We devel oped a modified valve-sparing reimplantation technique for avoiding leaflet damage. This was achieved by leaving a 'cushion' of aortic wall (8-10 mm) that, sewn on the Dacron graft, works as a 'damper' and prevents leaflets i njury during the systolic opening of the valve. for final judgment of this operative method long-term results are necessary. (C) 2001 The Internationa l Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. Al l rights reserved.