Long-term outcome after valve-preserving root surgery for patients with Marfan syndrome

Objective: Choice of root procedure for patients with Marfan syndrome (MFS) seems still controversial. We have applied both forms of valve-preserving root repair liberally according to their root geometry. We analyzed our long-term results after valve-preserving root surgery for MFS patients compared with propensity-score matching cohort. Methods: 604 patients underwent valve-preserving aortic root surgery between 1995 and 2011, of whom 33 MFS patients (31±12y, 16 male) underwent either remodeling (n=21) or reimplantation technique (n=12) and were followed-up echocardiographically. Initially reimplantation technique was performed in case with aortoventricular junction >29mm, however, no longer performed since January 2008. Since January 2009 external circular annuloplasty has been performed in addition to remodeling when aortoventricular junction was larger than 27mm. Using propensity-score matching, comparable non-MFS patient (n=33) were identified for the final analysis. Long-term outcomes with regard to late aortic vale regurgitation (AR)>II° or reoperation on the aortic valve were compared between groups. Results: Baseline characteristics and operative procedures were similar between the groups. Actuarial freedom from AR>II° at 10 years was 73.5±13.2% in MFS patients and 72.0±17.8% in non-MFS patients (P=0.9409). Actuarial freedom from reoperation at 10 years was 75.3±14.8% in MFS patients and 80.0±17.9% in non-MFS patients (P=0.7888). In Cox's proportional hazard's model, no independent risk factor including MFS was found for recurrent AR or reoperation. Within MFS patients alone, remodeling and reimplantation provided similar freedom from late AR>II° and reoperation up to 7 years postoperatively (P=0.5508, 0.9898, respectively). Conclusions: Long-term stability of valve-preserving aortic root repair was comparable between patients with or without MFS. Both forms of valve-preserving root repair could be applied to MFS patients primarily according to their root geometry. In MFS patients, valve stability after remodeling technique was not inferior to that after reimplantation technique.