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Ann Thorac Surg 2002;73:438-443
© 2002 The Society of Thoracic Surgeons

Original article: cardiovascular

Aortic root replacement in 271 Marfan patients: a 24-year experience1

Vincent L. Gott, MD*a, Duke E. Cameron, MDa, Diane E. Alejo, BAa, Peter S. Greene, MDa, Jay G. Shake, MDa, David J. Caparrelli, MDa, Harry C. Dietz, MDa

a Division of Cardiac Surgery, the Institute of Genetic Medicine and the Howard Hughes Medical Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

Accepted for publication September 19, 2001.

* Address reprint requests to Dr Gott, 618 Blalock Building, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287, USA
e-mail: vgott{at}csurg.jhmi.jhu.edu

Background. The introduction of composite graft repair of aortic root aneurysm by Hugh Bentall in 1968 promised Marfan patients the choice for a normal life expectancy. We performed our first Bentall composite graft procedure in 1976 and herein report our 24-year experience with 271 Marfan patients.

Methods. Between September 1976 and August 2000, 232 Marfan patients had a composite graft replacement of the aortic root, 15 patients received a homograft, and 24 had a valve-sparing procedure.

Results. Two hundred thirty-five Marfan patients underwent elective aortic root replacement with no 30-day mortality. Two early deaths occurred among 36 patients who underwent urgent or emergent operation. Eighty-three percent of patients in this series are currently alive. The actuarial freedom from thromboembolism, endocarditis, and reoperation on the residual aorta 20 years postoperatively was 93%, 90%, and 74%. Twenty-four patients have undergone valve-sparing procedures with encouraging results.

Conclusions. Elective aortic root replacement for Marfan patients can be performed with low operative risk. Elective repair before the aortic root reaches 6 cm in diameter is recommended to minimize risk of dissection and rupture.




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