Aortic root surgery in Marfan syndrome: Bentall procedure with the composite mechanical valved conduit versus aortic valve reimplantation with Valsalva graft

Abstract

Objectives: The aim of the study is to compare mid-term results of Bentall aortic root replacement with composite mechanical valved conduit and aortic valve reimplantation procedure using the Valsalva graft for the treatment of aortic root aneurysm in patients with Marfan syndrome.

Methods: We retrospectively compared data of 23 patients (mean age 38 + or - 14 years) who had undergone the Bentall procedure (group B) to those of 24 patients (mean age 36 + or - 12 years) who had undergone aortic valve reimplantation (group R) during a 14-year period. Follow-up (mean duration 65 + or - 44 months) was 100% complete.

Results: There were no operative deaths in either group. In group B, as compared with group R, preoperative aortic insufficiency (3.2 + or - 1.1/4 vs. 1.7 + or - 1.4/4, P < 0.001), ascending aorta diameter (55.8 + or - 4.9 vs. 44.1 + or - 8.7 mm, P = 0.001) were prevailing; cardiopulmonary bypass (107 + or - 51 vs. 145 + or - 32 min, P < 0.05) and aortic cross-clamp (77 + or - 17 vs. 116 + or - 30 min, P = 0.005) times were shorter. Eight-year survival and freedom from cardiac death and reoperation were 91 + or - 6, 96 + or - 4 and 100% in group B and 100, 100 and 91 + or - 6% in group R, respectively (P = NS for all comparisons). At follow-up, echocardiography showed significant improvement of left ventricular ejection fraction (0.60 + or - 0.10 vs. 0.52 + or - 0.09 preoperatively, P = 0.01) and end-systolic diameter (34 + or - 5 vs. 47 + or - 14 mm, P = 0.001) in group B and significant reduction of preoperative aortic insufficiency (0.7 + or - 1.0/4 vs. 1.7 + or - 1.4/4, P = 0.01) and aortic annulus (24 + or - 2.4 vs. 33 + or - 5 mm, P = 0.01) in group R.

Conclusion: In Marfan patients, the Bentall procedure is associated with excellent mid-term outcome. The reimplantation technique, adopted for less dilated aortas, provides similarly satisfactory results. The Valsalva graft seems, with time, to allow a stable aortic valve function.