External aortic root support for Marfan syndrome

Abstract

We have read the interesting article by Pepper and colleagues 1 about their experience on the external support of the aortic root in Marfan syndrome. This is a good contribution to the expanding literature about Marfan syndrome; however, there are few facts that should be clarified.First of all, 66 patients have been removed from the analysis for the comparison of the groups due to previous operations or re-operations. Why? Reoperation in the Marfan patients is an important fact that should be kept in mind in planning the operation. As we have reported before, 2 about 20% of our patients had R1 re-operations due to dilatations in the other segments of the aorta or mitral valve problems. Second, the follow-up data of the 20 patients are unclear. There is a figure of aortic dimensions but the time of the last postoperative examination from the time of the operation is unclear. In our report of the long-term results of the aortic root operations, Marfan syndrome was found to be associated with decreased long-term survival.3 Third, as the authors have stated, the aneurysm does not necessarily precedes aortic dissection in Marfan patients. That is why; the operation indication is lower than that of the normal population. 4 In order to take advantage of refraining from the use of anticoagulation, is it wise to take the risk of an aortic dissection in this segment? We have used similar external support for an abdominal aneurysm in one of our patients in a re-operation 2 in order to decrease the operation risk. However, a young population like this mandates a more definitive treatment in our point of view.We would like to thank the authors for their study and would like to hear their contributions to the discussion. Reply to Polat and colleaguesPolat and colleagues pose key questions about our study and the future of bespoke external aortic root support (EARS). The 66 patients excluded from analysis did not match prespecified criteria, namely a first-time, elective, aortic root operation, in the same time frame and setting. The 28 patients used for comparison had similar intraoperative myocardial ischaemic, cardiopulmonary bypass, and circulatory arrest exposure as 254 root replacements in Polat's experience. 1 We have shown that EARS obviates these potentially harmful, but necessary, surgical adjuncts to root replacement. 2Will EARS prevent aortic dissection within the supported segment? Our expectation is that it will reduce both the risk of dissection and, should it occur, the severity of its consequences. We have already shown that EARS holds the supported aortic segment at, or smaller than, its preoperative size.3 The dimensions across the three aortic sinuses were measured on duplicate magnetic resonance images of 37 non-operated Marfan patients and before and after (>1 year) images of the first 10 EARS patients. The 96 images were presented in random sequence to a radiologist blind to their identity and to the hypothesis. The stability of the external support, predicted from the characteristics of the material a...

A Comprehensive Study on a Medicinal and Edible Plant Scorzonera incisa DC., Discussing the Natural Limits of Phytochemical Profiling

“…Finally, most of the Scorzonera species are well‐known traditional remedies in different countries. There are several records to show the usage of the genus as wound healer, [10] analgesic, [11] hypolipidemic, [12] diuretic, [13] and antidiabetic [14] in Turkish folk medicine. Previous studies on the genus revealed the presence of different secondary metabolites such as terpenoids, flavonoids, phenolic acid esters, bibenzyls, coumarins, dihydroisocoumarins, and various bioactivities such as anti‐inflammatory, antioxidant, antimicrobial, antidiabetic, hepatoprotective, wound healing, and analgesic activities [15–20] .…”