Application of valve-sparing aortic root reimplantation for aortic root disorders in patients with Marfan syndrome / 第二军医大学学报

ABSTRACT

ObjectiveTo evaluate the appropriate indications, key points of surgical techniques, and early to midterm outcomes of valve-sparing aortic root reimplantation in patients with Marfan syndrome. MethodsThe clinical data of 52 patients with Marfan syndrome who underwent valve-sparing aortic root reimplantation in our department from June 2006 to July 2017 were retrospectively analyzed. Preoperative patient characteristics, surgical techniques, and follow-up outcomes were summarized. ResultsThe patients had a mean age of (36.6±14.5) years, with 35 males and 17 females. Severe aortic valve insufficiency (AI) was found in 37 cases (71.2%) preoperatively. Echocardiography indicated that the average diameter of aortic annulus, aortic sinus, and sinotubular junction of this cohort were 22-30 mm, 40-56 mm, and 34-51 mm, respectively. Pure valve-sparing aortic root reimplantation was performed in 40 patients presenting aortic root aneurysm, with a cross-clamp time of 61-108 min and a mean of (81.3±11.6) min, and with a cardiopulmonary bypass time of 88-129 min and a mean of (97.3±10.8) min. The other 12 patients with Stanford type A aortic dissection underwent concomitant total arch replacement and elephant trunk implantation in the descending aorta, with a cross-clamp time of 93- 126 min and a mean of (107.4±11.2) min, and with a cardiopulmonary bypass time of 127-180 min and a mean of (143.5±17.1) min. Vascular prostheses with a diameter of ≤30 mm were adopted in all patients. Aortic root bleeding was drained to the right atriums in 9 patients. Transesophageal echocardiography was performed in 42 cases before extracorporeal circulation removal, with 16 cases presenting no AI, 18 presenting trace AI, and 8 presenting mild AI. There was one in-hospital death (1.9%) and no secondary thoracotomy for bleeding or other major complications. The mean follow-up was (3.2±2.1) years, with 43 cases completed the follow-up and no death during follow-up. Echocardiography in the latest follow-up indicated that 6 cases presented no AI, 24 presented trace AI, 12 presented mild AI, and only one case presented moderate AI, with 97.7% (42/43) patients free from moderate AI. No case underwent aortic valve replacement for severe AI. There were 39 (90.7%) patients in New York Heart Association classIand 4 (9.3%) patients in classII . ConclusionApplication of valve-sparing aortic root reimplantation using vascular prostheses with appropriate diameter is safe and effective for suitable patients with Marfan syndrome, and can obtain satisfactory outcomes.