Background: Our current approach to aortic root disease in patients with Marfan syndrome is replacement with a composite valve graft, a technique with established excellent early and long-term results. The purpose of this report is to retrospectively review our results with aortic root replacement in Marfan patients and to discuss the status of several alternative techniques, chiefly aimed at eliminating the need for a mechanical valve, that are currently under investigation.
Patients and methods: In patients with Marfan syndrome, we perform aortic root replacement for all ascending aortic dissections and significant annuloaortic ectasia or aortic valvular insufficiency. We reserve concomitant mitral valve surgery for those patients with clinically significant regurgitation. From February 1991 through July 1996, 45 patients with Marfan syndrome underwent aortic root replacement; 44 of the patients (97.8%) had composite valve grafts placed. Thirteen patients (28.9%) required concomitant graft replacement of the transverse aortic arch and four patients (8.9%) underwent concurrent mitral valve replacement.
Results: There were no intraoperative deaths, two early deaths (4.4%), and no postoperative strokes. No patient has developed evidence of an anastomotic pseudoaneurysm nor graft infection during follow-up.
Conclusions: Composite valve graft replacement of the aortic root carries low morbidity and mortality, produces excellent long-term results, and currently remains the treatment of choice for proximal dissection or significant annulo-aortic ectasia in patients with Marfan syndrome. Alternative techniques are evolving; however, further long-term data demonstrating durability that compares favorably to established techniques will be required before recommending their routine use.