Outcomes after Valve-Preserving Root Surgery for Patients with Marfan Syndrome

Background and aim of the study: In patients with Marfan syndrome (MFS), valve reimplantation has been proposed as superior to root remodeling. In the present study, both forms of valve-preserving root repair were applied and mid-term results analyzed in MFS patients compared to a propensity score-matched cohort. Methods: Among 604 patients who underwent valve-preserving aortic root surgery between 1995 and 2011 at the authors' institution, 33 MFS patients (16 males, 17 females; mean age 31 +/- 12 years) underwent either remodeling (n = 21) or reimplantation (n = 12). All patients were followed up echocardiographically, and the outcome with regard to late aortic valve regurgitation (AR) grade >= II and reoperation on the aortic valve was compared between MFS patients and the matched cohort (n = 33). Results: Baseline characteristics and operative data were similar between the groups. Actuarial freedom from AR at seven years was 86 +/- 8% in MFS patients and 90 +/- 10% in matched non-MFS patients (p = 0.94). Actuarial freedom from reoperation at seven years was 90 +/- 7% in MFS patients and 100% in non-MFS patients (p = 0.79). In Cox's proportional hazard's model, no independent risk factor, including MFS, was found for recurrent AR or reoperation. Within the MFS patients, remodeling and reimplantation provided an almost identical freedom from late AR >= II and reoperation up to five years postoperatively (p = 0.55 and 0.99, respectively). Conclusion: The stability of valve-preserving aortic root repair was comparable between patients with or without MFS. Both forms of valve-preserving root repair can provide similar mid-term results for MFS patients, primarily according to their root geometry. However, additional long-term follow up data based on a larger number of patients are required to confirm the evidence obtained to date. The Journal of Heart Valve Disease 2012;21:615-622