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The Annals of Thoracic Surgery, Vol 52, 38-44, Copyright © 1991 by The Society of Thoracic Surgeons
VL Gott, RE Pyeritz, DE Cameron, PS Greene and VA McKusick
One hundred consecutive patients with the Marfan syndrome underwent
composite graft repair of an ascending aortic aneurysm between September
1976 and June 1989. Twenty-two patients had ascending aortic dissection at
the time of composite graft repair; 18 patients also had a mitral valve
procedure. There were no hospital deaths among 92 patients undergoing
elective repair. One of 8 patients undergoing emergency repair of a
ruptured aneurysm died in the operating room. The overall hospital
mortality rate was 1%. There have been ten late deaths among the 99
hospital survivors (10.1%). Five deaths occurred among the first 11
patients in this series and five occurred among the last 88 patients
(5.7%). Three late deaths resulted from composite graft endocarditis; 3
other patients with endocarditis are alive after aortic root replacement
with cryopreserved homografts. Late coronary dehiscence caused death in 1
patient and was successfully repaired in a second. Actuarial survival for
the 100 patients was 92.6% at 5 years and 75.8% at 10 years. Currently,
composite graft repair of Marfan aneurysms of the ascending aorta can be
performed with low hospital and late mortality. Marfan aneurysms with a
diameter of 6 cm or greater should be repaired with the Bentall composite
graft procedure, even if the patient is asymptomatic.
ARTICLES
Composite graft repair of Marfan aneurysm of the ascending aorta: results in 100 patients
Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
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