Aortic Valve–Sparing Operation in Marfan Syndrome: What Do We Know After a Decade?

Kallenbach, Klaus; Baraki, Hassina; Khaladj, Nawid; Kamiya, Hiroyuki; Hagl, Christian; Haverich, Axel; Kretzler, Matthias

doi:10.1016/j.athoracsur.2006.10.097

Cited by 84 publications

(40 citation statements)

References 10 publications

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“…The average follow-up for period for CVG in 13 studies reporting follow up duration was 7.14 years and the average follow up period for VSRR in 20 studies reporting follow up duration was 4.5 years. There were 2 studies reporting the outcomes of CVG only (11,19) and 8 studies reporting the outcomes of VSRR only (15,17,20,22,23,26,28,31). Thirteen studies reported outcomes for both CVG and VSRR (12)(13)(14)16,18,21,24,25,27,29,30,32,33).…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of surgical outcomes in Marfan patients undergoing aortic root surgery by composite-valve graft or valve sparing root replacement

Flynn

Tian

Wilson-Smith

et al. 2017

Ann. Cardiothorac. Surg.

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Background: A major, life-limiting feature of Marfan syndrome (MFS) is the presence of aneurysmal disease. Cardiovascular intervention has dramatically improved the life expectancy of Marfan patients.Traditionally, the management of aortic root disease has been undertaken with composite-valve graft replacing the aortic valve and proximal aorta; more recently, valve sparing procedures have been developed to avoid the need for anticoagulation. This meta-analysis assesses the important surgical outcomes of the two surgical techniques.Methods: A systematic review and meta-analysis of 23 studies reporting the outcomes of aortic root surgery in Marfan patients with data extracted for outcomes of early and late mortality, thromboembolic events, late bleeding complications and surgical reintervention rates.Results: The outcomes of 2,976 Marfan patients undergoing aortic root surgery were analysed, 1,624 patients were treated with composite valve graft (CVG) and 1,352 patients were treated with valve sparing root replacement (VSRR). When compared against CVG, VSRR was associated with reduced risk of thromboembolism (OR =0.32; 95% CI, 0.16-0.62, P=0.0008), late hemorrhagic complications (OR =0.18; 95% CI, 0.07-0.45; P=0.0003) and endocarditis (OR =0.27; 95% CI, 0.10-0.68; P=0.006). Importantly there was no significant difference in reintervention rates between VSRR and CVG (OR =0.89; 95% CI, 0.35-2.24; P=0.80).Conclusions: There is an increasing body of evidence that VSRR can be reliably performed in Marfan patients, resulting in a durable repair with no increased risk of re-operation compared to CVG, thus avoiding the need for systemic anticoagulation in selected patients.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of surgical outcomes in Marfan patients undergoing aortic root surgery by composite-valve graft or valve sparing root replacement

Flynn

Tian

Wilson-Smith

et al. 2017

Ann. Cardiothorac. Surg.

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“…AR is, however, a common complication, requiring reoperation in 20% of patients after 10 years. 66 Long-term results of valvesparing aortic root replacement in Marfan syndrome are still unknown. Women have, on average, a 5 mm smaller aorta, only partly explained by a smaller BSA.…”

Section: Medical Therapymentioning

confidence: 99%

ESC Guidelines for the management of grown-up congenital heart disease (new version 2010)

Baumgartner¹,

Bonhoeffer²,

Groo³

et al. 2012

Revista Portuguesa de Cardiologia (English Edition)

568

907

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“…Aortic root size also has prognostic implications in patients with pathology such as Marfan disease, 1 and clear visualization is important in relation to surgery that preserves the aortic valve and root. Measurements of aortic root dimensions may also be clinically relevant in patients with aortic regurgitation.…”

mentioning

confidence: 99%

Aortic Root Measurement by Cardiovascular Magnetic Resonance

Burman

Keegan

Kilner

2008

Circ: Cardiovascular Imaging

161

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Background-Cardiovascular magnetic resonance is widely used for aortic root visualization and measurement, but methods still need to be standardized. Our aim was to identify appropriate planes of acquisition and lines of measurement and record corresponding normal values. Methods and Results-We studied 120 healthy volunteers, 10 of each gender in each decile between 20 and 80 years, by using a 1.5-T cardiovascular magnetic resonance system. Steady-state free precession cine acquisitions aligned with the left ventricular outflow tract in oblique sagittal and coronal orientations were used to locate 2 sinus planes that transected the root at its widest point in its maximally expanded systolic and at its end diastolic positions. We measured the cusp-cusp and the cusp-commissure dimensions in these cine planes, each as the average of 3. Diastolic cuspcommissure dimensions were smaller than diastolic cusp-cusp dimensions (32.0Ϯ3.5 mm versus 34.6Ϯ4.0 mm in men, 28.4Ϯ2.8 mm versus 30.7Ϯ3.3 mm in women, PϽ0.001 for both). The diastolic cusp-commissure dimensions increased by 0.9 mm per decade in men and 0.7 mm per decade in women (PϽ0.001 for both) and gave higher R 2 values with respect to age and body surface area (0.40 for men, 0.27 for women) than diastolic cusp-cusp, systolic cusp-commissure, or sinus measurements made in the left ventricular outflow tract planes. Conclusions-The results indicate the importance of consistent methods for measurement of the aortic root by cardiovascular magnetic resonance. We recommend diastolic cusp-commissure measurements, which yielded favorable R 2 values with respect to age and body surface area and were found to correspond closely with reference echocardiographic root measurements recorded in the Framingham cohort. We recorded reference values for these and other possible aortic root measurements by cardiovascular magnetic resonance. (Circ Cardiovasc Imaging. 2008;1:104-113.)

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Aortic Valve–Sparing Operation in Marfan Syndrome: What Do We Know After a Decade?

Cited by 84 publications

References 10 publications

Systematic review and meta-analysis of surgical outcomes in Marfan patients undergoing aortic root surgery by composite-valve graft or valve sparing root replacement

Systematic review and meta-analysis of surgical outcomes in Marfan patients undergoing aortic root surgery by composite-valve graft or valve sparing root replacement

ESC Guidelines for the management of grown-up congenital heart disease (new version 2010)

Aortic Root Measurement by Cardiovascular Magnetic Resonance

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