Ann Thorac Surg 1994;58:1457-1461
© 1994 The Society of Thoracic Surgeons
Articles
New composite graft repair for patients with and without Marfan's syndrome
Akio Suzuki, MD, PhD*,
Jun Amano, MD, PhD,
Makoto Sunamori, MD, PhD,
Tohru Sakamoto, MD, PhD,
Hiroyuki Tanaka, MD, PhD
Department of Cardiothoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
Accepted for publication May 2, 1994.
* Address reprint requests to Dr Suzuki, Department of Cardiothoracic Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, Japan.
 |
Abstract
|
|---|
We developed a new composite graft repair technique to prevent the complications associated with Bentall-type procedures. The technique consists of the creation of a double proximal suture line and direct coronary artery implantation as a Carrel patch without wrapping. We retrospectively compared the outcome in patients with Marfan's syndrome (n = 16) and other disorders (aortitis, 11 patients; degenerative disease, 18 patients) who had undergone this procedure. In patients with Marfan's syndrome, there was one hospital death and six deaths during long-term follow-up. Among patients with Takayasu's arteritis, there was one hospital death and one late death. There was one late death in the patients with degenerative disease. No mortality or complications directly related to the surgical procedure occurred in any group. The high late mortality in patients with Marfan's syndrome was primarily due to distal aortic dissection or rupture. Thus, the major complications associated with Bentall-type procedures can be prevented through the use of our new composite graft technique. However, close serial follow-up, careful blood pressure control, and early detection and treatment of distal recurrence are mandatory in the postoperative management of patients with Marfan's syndrome.
|
References
|
|---|
- Bentall HH, DeBono A. A technique for complete replacement of the ascending aorta Thorax 1968;23:338-339.[Abstract/Free Full Text]
- Bentall HH. Operation for ascending aortic aneurysm and aortic regurgitation—pathological influence on survival Jpn J Surg 1987;17:425-430.[Medline]
- Cabrol C, Pavie A, Gandjbakhch I, Villemot JP, Guiraudon G. Complete replacement of the ascending aorta with reimplantation of the coronary arteries: new surgical approach J Thorac Cardiovasc Surg 1981;81:309-315.[Abstract]
- Svensson LG, Crawford ES, Coselli JS, Safi HJ, Hess KR. Impact of cardiovascular operation on survival in the Marfan patient Circulation 1989;80(Suppl 1):233-242.
- Suzuki A, Amano J, Tanaka H, Sakamoto T, Sunamori M. Surgical consideration of aortitis involving the aortic root Circulation 1989;80(Suppl 1):222-232.
- Trotter SE, Olssen EGJ. Marfan's disease and Erdheim's cystic medionecrosis. A study of their pathology Eur Heart J 1991;12:83-87.[Abstract/Free Full Text]
- Murdoch JL, Walker BA, Halpern BL, Kuzma JW, McKusick VA. Life expectancy and causes of death in the Marfan syndrome N Engl J Med 1972;286:804-808.[Medline]
- Marsalese DL, Moodie DS, Vacane M, et al. Marfan's syndrome: natural history and long-term follow-up of cardiovascular involvement J Am Coll Cardiol 1989;14:422-428.[Medline]
- Gallotti R, Ross DM. The Marfan syndrome: surgical technique and follow-up in 50 patients Ann Thorac Surg 1979;29:428-433.
- Kouchoukos NT, Wareing TH, Murphy SF, Perrillo JB. Sixteen-year experience with aortic root replacement. Results of 172 operations Ann Surg 1991;214:308-320.[Medline]
- Gott VL, Pyeritz RE, Cameron DE, Greene PS, MuKusick VA. Composite graft repair of Marfan aneurysm of the ascending aorta: results of 100 patients Ann Thorac Surg 1991;52:38-45.[Abstract/Free Full Text]
- Beighton P, de Paepe A, Danks D, et al. International nosology of heritable disorders of connective tissue, Berlin Am J Med Genet 1988;29:581-594.[Medline]
- Kaplan EL, Meier P. Nonparametric estimation from incomplete observation J Am Stat Assoc 1958;53:457-481.
- Gehan EA. A generalized Wilcoxon test for comparing arbitrarily single censored samples Biometrika 1965;52:203-223.[Abstract/Free Full Text]
- Lewis CTP, Cooley DA, Murphy MC, Talledo O, Vega D. Surgical repair of aortic root aneurysms in 280 patients Ann Thorac Surg 1992;53:38-46.[Abstract/Free Full Text]
- Barbetseas J, Crawford ES, Safi HJ, Coselli JS, Quinones MA. Doppler echocardiographic evaluation of pseudoaneurysms complicating composite grafts of the ascending aorta Circulation 1992;85:212-222.[Abstract/Free Full Text]
- Piehler JM, Pluth JR. Replacement of the ascending aorta and aortic valve with a composite graft in patients with nondisplaced coronary ostia Ann Thorac Surg 1982;33:406-409.[Abstract/Free Full Text]
- Bachet J, Brizard CH, Goudot B, et al. Repeated surgery for recurrent dissection of the aorta Eur J Cardiothorac Surg 1990;4:238-244.[Abstract/Free Full Text]
Top
Abstract
References
