Patient-tailored aortic root repair in adult marfanoid patients: Surgical considerations and outcomes.
OBJECTIVE
The aim of the study was to evaluate the operative and functional results after individual, patient-tailored aortic root repair in marfanoid patients.


METHODS
Among 518 patients who underwent operation between 2002 and January 2016, using patient-tailored aortic root repair with isolated sinus replacement, 42 patients fulfilled the original Ghent criteria. None/trivial, mild, moderate, and severe insufficiency grades were present in 5, 16, 10, and 11 patients, respectively.


RESULTS
The repair was adjusted to the existing aortic annulus diameter. Replacement of 1, 2, or 3 sinuses of Valsalva was performed in 1, 14, and 27 patients, respectively. Concomitant cusp repair was performed in 17 patients (40.5%), and 10 patients (23.8%) underwent arch repair (total in 3). All patients survived surgery, and the follow-up (mean, 6.1 ± 3.1; range, 0.8-14.2 years) was 100% complete. No patient had a change in the form or size of the aortic neo-root, especially the size of aortic annulus and sinotubular junction during the follow-up time. No and trivial/mild insufficiency were present in 22 and 18 patients, respectively, and 2 patients with recurrent aortic insufficiency caused by cusp pathology underwent aortic valve replacement 43 and 66 months after the primary surgery, respectively. Thus, the estimated survival free from aortic valve/root reoperation for any reason at 5 and 8 years was 96.8% ± 3.2% and 91.4% ± 6.0%, respectively.


CONCLUSIONS
Patient-tailored root repair using isolated sinus replacement is an effective and durable method of valve-sparing repair in select marfanoid patients with a satisfactory quality of aortic cusps, which seems to be decisive for long-term valve function.
['Urbanski|Paul P|PP|', 'Jankulowski|Atanas|A|', 'Morka|Aleksandra|A|', 'Irimie|Vadim|V|', 'Zhan|Xiaochun|X|', 'Zacher|Michael|M|', 'Diegeler|Anno|A|']
D000328:Adult D001011:Aorta D001021:Aortic Valve D001022:Aortic Valve Insufficiency D019917:Blood Vessel Prosthesis Implantation D058385:Cardiac Valve Annuloplasty D000072226:Computed Tomography Angiography D004452:Echocardiography D005260:Female D005500:Follow-Up Studies D005858:Germany D006801:Humans D008297:Male D008382:Marfan Syndrome D008875:Middle Aged D009929:Organ Size D010043:Outcome and Process Assessment, Health Care D063868:Patient Outcome Assessment D012008:Recurrence
Marfan syndrome aortic root remodeling aortic valve reconstruction valve-sparing root repair