[Surgical treatment for proximal ascending aortic lesion in Marfan syndrome; retrospective evaluation of the initial surgical technique at late reoperation].

OBJECTIVE

To retrospectively evaluate the initial surgical technique for proximal ascending aortic lesion in Marfan syndrome at late reoperation.

MATERIALS AND METHODS

Fourteen Marfan patients who were operated on for annuloaortic ectasia (AAE) with or without type A aortic dissection required reoperation through re-median sternotomy for various reasons in the late postoperative period. Average time interval between the initial operation and the late reoperation was 8.4 years. Reoperative procedures used in this series included re-composite graft replacement in 1 patient, total arch replacement (TAR) in 1, and re-composite graft replacement with TAR in 12.

RESULTS

There were 2 in-hospital deaths (14.3%); one patient died of low output syndrome (LOS) after combined Bentall and TAR while the other suffered a sudden death probably due to acute myocardial infarction after combined Cabrol and TAR procedure. Eight patients underwent additional descending or thoracoabdominal aortic replacement in the late postoperative period.

CONCLUSIONS

Button technique (Carrel patch technique) with small side hole in the composite graft is the operative procedure of choice for AAE to reduce the risk of complications related to coronary artery anastomosis. Button technique and concomitant TAR that helps to avoid the possibility of reoperation on the aortic arch through re-median sternotomy, is the preferred technique for AAE with type A aortic dissection.