Valve-sparing and valve-replacing techniques for aortic root replacement in patients with Marfan syndrome: Analysis of early outcome

J Thorac Cardiovasc Surg. 2009 May;137(5):1124-32. doi: 10.1016/j.jtcvs.2009.03.023.


Objective: A prospective, international registry study was initiated to provide contemporary comparative data on short-term clinical outcomes after aortic valve-sparing and aortic valve-replacing root operations in patients with Marfan syndrome. The purpose of this initial report is to describe the study design and to compare early outcomes in the first 151 enrolled patients.

Methods: We assessed 30-day outcomes in 151 patients who met strict Ghent diagnostic criteria for Marfan syndrome and underwent aortic root replacement with either valve-replacing (n = 46) or valve-sparing techniques (n = 105) at one of 18 participating centers. In the valve replacement group, a mechanical composite valve graft was used in 39 (85%) patients and a bioprosthetic valve in 7 (15%). In the valve-sparing group, David V procedures were performed in 57 (54%) patients, David I in 38 (36%), David IV in 8 (8%), Florida sleeve in 1 (1%), and Yacoub remodeling in 1 (1%).

Results: No in-hospital or 30-day deaths occurred. Despite longer crossclamp and cardiopulmonary bypass times in the valve-sparing group, there were no significant between-group differences in postoperative complications. Thirty-day valve-related complications occurred in 2 (4%) patients undergoing valve replacement and in 3 (3%) undergoing valve-sparing procedures (P = .6).

Conclusions: The analysis of early outcomes revealed that valve-sparing techniques were the most common approach to root replacement in patients with Marfan syndrome in these centers. The complexity of valve-sparing root replacement did not translate into any demonstrable adverse early outcomes. Subsequent analysis will compare the 3-year durability of these two surgical approaches.

Publication types

  • Comparative Study
  • Corrected and Republished Article
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aorta, Thoracic / physiopathology
  • Aorta, Thoracic / surgery
  • Aortic Valve / physiopathology
  • Aortic Valve / surgery*
  • Bioprosthesis
  • Cardiac Surgical Procedures / methods
  • Cardiopulmonary Bypass / methods
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Heart Valve Diseases / etiology
  • Heart Valve Diseases / mortality
  • Heart Valve Diseases / surgery*
  • Heart Valve Prosthesis
  • Heart Valve Prosthesis Implantation / methods*
  • Heart Valve Prosthesis Implantation / mortality
  • Hospital Mortality / trends*
  • Humans
  • Male
  • Marfan Syndrome / complications*
  • Marfan Syndrome / surgery
  • Middle Aged
  • Postoperative Complications / mortality
  • Postoperative Complications / physiopathology
  • Probability
  • Prospective Studies
  • Prosthesis Failure
  • Registries
  • Risk Assessment
  • Survival Analysis
  • Time Factors
  • Treatment Outcome
  • Young Adult