TY - JOUR
T1 - Midterm outcomes of aortic root surgery in patients with Marfan syndrome
T2 - A prospective, multicenter, comparative study
AU - Aortic Valve Operative Outcomes in Marfan Patients Study Group
AU - Coselli, Joseph S.
AU - Volguina, Irina V.
AU - LeMaire, Scott A.
AU - Connolly, Heidi M.
AU - Sundt, Thoralf M.
AU - Milewicz, Dianna M.
AU - Dietz, Harry C.
AU - Amarasekara, Hiruni S.
AU - Green, Susan Y.
AU - Zhang, Qianzi
AU - Schaff, Hartzell V.
AU - Miller, D. Craig
N1 - Publisher Copyright:
© 2021 The American Association for Thoracic Surgery
PY - 2023/5
Y1 - 2023/5
N2 - Objective: The objective of this study was to compare midterm outcomes of aortic valve-replacing root replacement (AVR) and aortic valve-sparing root replacement (AVS) operations in patients with Marfan syndrome. Methods: Patients who met strict Ghent diagnostic criteria for Marfan syndrome and who underwent either AVR or AVS between March 1, 2005 and December 31, 2010 were enrolled in a 3-year follow-up prospective, multicenter, international registry study; the study was subsequently amended to include 20-year follow-up. Enrollees were followed clinically and echocardiographically. Results: Of the 316 patients enrolled, 77 underwent AVR and 239 underwent AVS; 214 gave reconsent for 20-year follow-up. The median clinical follow-up time for surviving patients was 64 months (interquartile range, 42-66 months). Survival rates for the AVR and AVS groups were similar at 88.2% ± 4.4% and 95.0% ± 1.5%, respectively (P =.1). Propensity score-adjusted competing risk modeling showed associations between AVS and higher cumulative incidences of major adverse valve-related events, valve-related morbidity, combined structural valve deterioration and nonstructural valve dysfunction, and aortic regurgitation ≥2+ (all P <.01). No differences were found for reintervention (P =.7), bleeding (P =.2), embolism (P =.3), or valve-related mortality (P =.8). Conclusions: Five years postoperatively, major adverse valve-related events and valve-related morbidity were more frequent after AVS than after AVR procedures, primarily because of more frequent aortic valve dysfunction. No between-group differences were found in rates of survival, valve-related mortality, reintervention on the aortic valve, or bleeding. We plan to follow this homogenous cohort for 20 years after aortic root replacement.
AB - Objective: The objective of this study was to compare midterm outcomes of aortic valve-replacing root replacement (AVR) and aortic valve-sparing root replacement (AVS) operations in patients with Marfan syndrome. Methods: Patients who met strict Ghent diagnostic criteria for Marfan syndrome and who underwent either AVR or AVS between March 1, 2005 and December 31, 2010 were enrolled in a 3-year follow-up prospective, multicenter, international registry study; the study was subsequently amended to include 20-year follow-up. Enrollees were followed clinically and echocardiographically. Results: Of the 316 patients enrolled, 77 underwent AVR and 239 underwent AVS; 214 gave reconsent for 20-year follow-up. The median clinical follow-up time for surviving patients was 64 months (interquartile range, 42-66 months). Survival rates for the AVR and AVS groups were similar at 88.2% ± 4.4% and 95.0% ± 1.5%, respectively (P =.1). Propensity score-adjusted competing risk modeling showed associations between AVS and higher cumulative incidences of major adverse valve-related events, valve-related morbidity, combined structural valve deterioration and nonstructural valve dysfunction, and aortic regurgitation ≥2+ (all P <.01). No differences were found for reintervention (P =.7), bleeding (P =.2), embolism (P =.3), or valve-related mortality (P =.8). Conclusions: Five years postoperatively, major adverse valve-related events and valve-related morbidity were more frequent after AVS than after AVR procedures, primarily because of more frequent aortic valve dysfunction. No between-group differences were found in rates of survival, valve-related mortality, reintervention on the aortic valve, or bleeding. We plan to follow this homogenous cohort for 20 years after aortic root replacement.
KW - Marfan syndrome
KW - aortic root replacement
KW - aortic valve regurgitation
KW - aortic valve replacement procedure
KW - aortic valve-sparing procedure
KW - outcomes
KW - valve-related complications
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U2 - 10.1016/j.jtcvs.2021.08.064
DO - 10.1016/j.jtcvs.2021.08.064
M3 - Article
C2 - 34629178
AN - SCOPUS:85115623647
SN - 0022-5223
VL - 165
SP - 1790-1799.e12
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 5
ER -