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Current practice in Marfan's aortic root surgery: reconstruction with aortic valve preservation or replacement? What to do with the mitral valve?

BACKGROUND
Until recently the surgical treatment of aneurysms of the aortic root in patients with the Marfan syndrome consisted of composite replacement of the aortic valve and ascending aorta. At the present, almost one-half of these patients can have reconstruction of the aortic root with preservation of the aortic valve. The mitral valve can also be frequently preserved.


PATIENTS AND METHODS
From 1988 to 1996, 46 patients with the Marfan syndrome and aortic root aneurysm underwent cardiac surgery; the aortic valve was preserved in 23 and replaced in 26. The mitral valve was repaired in 3 patients who had aortic valve-sparing operations, and it was repaired in 3 and replaced in 3 who had aortic valve replacement. Both groups of patients had similar clinical profile.


RESULTS
There were 2 operative deaths among patients who had aortic valve replacement but neither one was valve-related. One patient who had aortic valve-sparing operation needed aortic valve replacement 2 years postoperatively. There were no other valve-related complications in this group. The actuarial survival was 100% at 5 years for this group. Four patients needed reoperations for valve-related complications in the group who had composite replacement of the aortic valve and ascending aorta. The actuarial survival was 88% +/- 4% at 5 years in this group.


CONCLUSIONS
Although the number of patients in each group is small and the follow-up relatively short, aortic valve-sparing operations have given gratifying results and may prove superior to valve replacement in patients with the Marfan syndrome.