Aortic Valve-Sparing Surgery in Marfan Syndrome

作者：Nachum Eyal^*; Shinfeld Amichay; Kogan Alexander; Preisman Sergey; Levin Shany; Raanani Ehud

来源：Israel Medical Association Journal, 2013, 15(8): 439-442.

• Marfan syndrome
• aortic valve root aneurysm
• aortic valve-sparing surgery (AVS)
• David procedure

Background: Patients with Marfan syndrome are referred for cardiac Surgery due to root aneurysm with or without aortic valve regurgitation. Because these patients are young and frequently present with normal-appearing aortic cusps, valve sparing is often recommended. However, due to the genetic nature of the disease, the durability of such surgery remains uncertain.
Methods: February 2004 and June 2012, 100 patients in our department suffering from aortic aneurysm with aortic valve regurgitation underwent elective aortic valve-sparing surgery. Of them, 30 had Marfan syndrome, were significantly younger (30 13 vs. 53 16 years), and had a higher percentage of root aneurysm, compared with ascending aorta aneurysm in their non-Marfan counterparts. We evaluated the safety, durability, clinical and echocardiographic mid-term results of these patients.
Results: While no early deaths were reported in either group, there Were a few major early complications in both groups. At follow-up (teaching 8 years with a mean of 34 26 months) there were no late deaths, and few major late complications in the Marfan group. Altogether, 96% and 78% of the patients were in New York Heart Association functional class I-II in the Marfan and non-Marfan groups respectively. None of the Marfan patients needed reoperation on the aortic valve. Freedom from recurrent aortic valve regurgitation > 3+ was 94% in the Marfan patients.
Conclusions: Aortic valve-sparing surgery in Marfan symdrome patients is safe and yields good mid-term clinical outcomes.

• 出版日期2013-8