Comparison between valve-sparing root replacement and Bentall procedure in patients with Marfan syndrome

抄録

Background: Bentall procedure is standard procedure for aortic root aneurysm or dissection in patients with Marfan syndrome. The purpose of this study was to evaluate whether valve-sparing root replacement (VSR) can be an alternative to Bentall procedure in patients with Marfan syndrome. Methods: Thirteen patients with Marfan syndrome underwent aortic root replacement between 1999 and 2017. Bentall procedure with a mechanical valve was performed in 9 patients and VSR was performed in 4. The mean durations of follow-up were 103.1 ± 61.6 months in Bentall and 35.0 ± 26.4 months in VSR. Results: There was no in-hospital death in both procedures. Reoperation for bleeding was performed in one patient after Bentall procedure. One patient died because of unknown cause in the Bentall group. No death occurred in the VSR group during a follow-up period. There was no difference in mortality between two groups. In the Bentall group, subarachnoid hemorrhage was developed in one patient and cerebral hemorrhage in one, while there was no hemorrhage or thromboembolism in the VSR group. Echocardiography showed improvement of aortic valve regurgitation grade (pre-operation 2.9 ± 1.4 vs postoperation 0.5 ± 0.4, P = 0.03) in all patients of the VSR group, and there was no reoperation for aortic valve after VSR. Conclusion: The significant inferiority of both early and late result in VSR could not be observed. VSR avoids the risk of complications associated with anticoagulation, which can be a preferable alternative to Bentall procedure in patients with Marfan syndrome.