期刊
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
卷 61, 期 6, 页码 1318-1325出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/ejcts/ezac050
关键词
Marfan syndrome; Loeys-Dietz syndrome; valve-sparing; reimplantation; annuloaortic ectasia
This study evaluated the surgical outcomes of valve-sparing root replacement in patients with Marfan syndrome (MFS) and Loeys-Dietz syndrome (LDS). The results showed that patients with MFS and LDS had similar incidences of aortic valve insufficiency and aortic valve reoperation. However, patients with LDS had a higher risk of aortic dissection and aortic reoperation after the initial operation.
OBJECTIVES The goal of this study was to evaluate the surgical outcomes of a valve-sparing root replacement using the reimplantation technique for annuloaortic ectasia in patients with Marfan syndrome (MFS) and in those with Loeys-Dietz syndrome (LDS). METHODS We reviewed 103 patients with MSF with mutations in the fibrillin-1 gene and 28 patients with LDS with mutations in the transforming growth factor-beta receptor and 2, SMAD3 and transforming growth factor beta-2 from 1988 to 2020. RESULTS Forty-four (42.7%) patients with MFS [26 men, 31 (7.6) years] and 10 (35.7%) patients with Loeys-Dietz syndrome (LDS) [7 men, 22 (standard deviation: 8.6) years] who had no aortic dissection and underwent valve-sparing root replacement were included. The preoperative sinus diameter [46 (45-50.5) mm in those with MFS vs 48 (47-50) mm in those with LDS, p = 0.420] and the percentage of aortic insufficiency > grade 2+ [31.8% (10/44) in patients with MFS vs 10.0% (1/10) in those with LDS, p = 0.667] revealed no significant differences between the 2 groups. The cumulative incidences of aortic insufficiency greater than grade 1 (p = 0.588) and aortic valve reoperation (p = 0.310) were comparable between the 2 groups. Patients with LDS had a higher tendency towards aortic dissection after the initial operation (p = 0.061) and a significantly higher cumulative incidence of aortic reoperation (p = 0.003) versus those with MFS. CONCLUSIONS Patients with MFS and those with LDS showed similar cumulative incidences of recurrent aortic valve insufficiency and aortic valve reoperation. Those with LDS revealed a higher cumulative incidence of aortic reoperation and a greater tendency towards aortic dissection after the initial operation compared with those with MFS.
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