Re-do after Previous Ascending Aorta and Aortic Root Surgery in Patients with Marfan Syndrome

Sergey Rychin, Leo Bockeria, Vladimir Mironenko, Valeriy Umarov, Murat Kokoev

A.N. Bakoulev NMRCCS , Moscow, Russia

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – C

Abstract

The aim of the study is to evaluate the residual aorta after the aortic root replacement in Marfan syndrome patients/

Methods: Since 1983, 232 patients with Marfan syndrome have undergone aortic root replacement (mean age 33,5±10,3, 140 male). 64 cases had DeBakey type I aortic dissection (17 acute and 47 chronic), 54 had DeBakey II aortic dissection (6 acute and 48 chronic), and 114 had aortic aneurysm without dissection. For the patients with DeBakey I aortic dissection, 11 aortic arch replacement were performed.Hospital mortalitywas8,6%.

Results.Of the 212 surviving patients at different times after the first operation, aortic complications were noted in 46 patients (21.7%). They were more often observed in patients with dissection of the descending thoracic and abdominal aorta at the time of the first operation compared with patients with intact distal aorta - 65% versus 12.8%, respectively (p <0.0001).Thirty nine reoperations on the residual aorta after previous the aortic root replacementwere undergone on twenty-nine patients.Among the patients reoperated on the distal part of the thoracic aorta 17 (77.7%) were previously operated for theDeBakey type I aortic dissection, and 12 - aneurysms of the ascending aorta without dissection.Hospital mortality in this group of patients was 13.7% (4 patients).Four patients with DeBakey type I aortic dissectionunderwent 2 or more repeated operations.

Conclusion: Careful postoperative observation of patients with Marfan syndrome is necessary for the timely detection of asymptomatic aortic changes requiring surgical correction. Reoperations on the distal aorta are more often required for patients with theDeBakey type I aortic dissectionand a larger diameter of the residual aorta. Expansion of the initial intervention on the arch of the aorta can be recommended to such patients provided it is possible to safely perform it.