Original article: cardiovascularAortic root replacement in 271 Marfan patients: a 24-year experience1
Section snippets
Patient selection
Two hundred seventy-one patients underwent aortic root replacement between September 1976 and August 2000. Two hundred thirty-two had a composite graft repair, 15 had aortic root replacement with a homograft, and 24 of the patients had a valve-sparing procedure. All patient data were entered into a computerized patient registry; late follow-up data were obtained from clinical records and direct contact with patients and their primary physicians. Late follow-up was achieved in 92% of the 271
Preoperative patient characteristics
One hundred ninety-two of the 271 patients were men (71%) and 79 were women (29%). Mean patient age was 33 years (range, 1.5 to 73.3 years). Forty-eight of the 271 patients (18%) had dissection of the ascending aorta (Table 1); 21 were acute dissections and 27 were chronic (more than 14 days old). Mean diameter of the ascending aorta in 229 adult patients in which this measurement was noted in the hospital chart was 6.8 cm (range, 4.0 to 13 cm). The mean diameter of the 43 ascending aortas with
Comment
The introduction of the composite graft–valve procedure by Bentall and DeBono in 1968 dramatically changed the bleak outlook for patients with Marfan aneurysm of the ascending aorta. A recent survey of 10 major Marfan surgical centers worldwide reported an operative mortality rate of 1.5% for Marfan patients undergoing elective repair of aortic root aneurysms [10]. In that survey, 455 Marfan patients had elective repair of aortic root aneurysm; 117 had urgent repair (1 to 7 days after surgical
Acknowledgements
This study was supported in part by the Dana and Albert “Cubby” Broccoli Center for Aortic Diseases at the Johns Hopkins Medical Institutions, by National Institutes of Health Grant RO1-AR41135, by the Howard Hughes Medical Institute, and by the Smilow Family Foundation.
The authors thank Drs Michael Acker, Michael Borkon, Robert Brawley, Alfred Casale, John Conte, Timothy Gardner, John Laschinger, Mark Redmond, Bruce Reitz, and Scott Stuart for allowing us to include their patients in this
References (16)
- et al.
Composite graft repair of Marfan aneurysm of the ascending aorta
Ann Thorac Surg
(1991) - et al.
An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta
J Thorac Cardiovasc Surg
(1992) - et al.
Eleven-year experience with composite graft replacement of the ascending aorta and aortic valve
J Thorac Cardiovasc Surg
(1986) Un cas de déformation congénitale des quatre membres, plus prononcée aux extrémités, caractérisée par l’allongement des os avec un certain degré d’amincissement
Bull Soc Hosp Paris
(1896)- et al.
Congenital aneurysmal dilatation of aorta associated with arachnodactyly
Bull Johns Hopkins Hosp
(1943) Cardiovascular aspects of Marfan syndromeheritable disorder of connective tissue
Circulation
(1955)- et al.
Life expectancy and causes of death in the Marfan syndrome
N Engl J Med
(1972) - et al.
A technique for complete replacement of the ascending aorta
Thorax
(1968)
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This manuscript was adapted in part from the William W. L. Glenn Lecture presented by Dr Gott at the American Heart Association Meeting, New Orleans, LA, Nov 13, 2000.