Early and 1-year outcomes of aortic root surgery in patients with Marfan syndrome: A prospective, multicenter, comparative study

Joseph S. Coselli, Irina V. Volguina, Scott A. Lemaire, Thoralf M. Sundt, Heidi M. Connolly, Elizabeth H. Stephens, Hartzell V Schaff, Dianna M. Milewicz, Luca A. Vricella, Harry C. Dietz, Charles G. Minard, D. Craig Miller

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Abstract

Objective To compare the 1-year results after aortic valve-sparing (AVS) or valve-replacing (AVR) aortic root replacement from a prospective, international registry of 316 patients with Marfan syndrome (MFS). Methods Patients underwent AVS (n = 239, 76%) or AVR (n = 77, 24%) aortic root replacement at 19 participating centers from 2005 to 2010. One-year follow-up data were complete for 312 patients (99%), with imaging findings available for 293 (94%). The time-to-events were compared between groups using Kaplan-Meier curves and Cox proportional hazards models. Results Two patients (0.6%) - 1 in each group - died within 30 days. No significant differences were found in early major adverse valve-related events (MAVRE; P =.6). Two AVS patients required early reoperation for coronary artery complications. The 1-year survival rates were similar in the AVR (97%) and AVS (98%) groups; the procedure type was not significantly associated with any valve-related events. At 1 year and beyond, aortic regurgitation of at least moderate severity (≥2+) was present in 16 patients in the AVS group (7%) but in no patients in the AVR group (P =.02). One AVS patient required late AVR. Conclusions AVS aortic root replacement was not associated with greater 30-day mortality or morbidity rates than AVR root replacement. At 1 year, no differences were found in survival, valve-related morbidity, or MAVRE between the AVS and AVR groups. Of concern, 7% of AVS patients developed grade ≥2+ aortic regurgitation, emphasizing the importance of 5 to 10 years of follow-up to learn the long-term durability of AVS versus AVR root replacement in patients with MFS.

Original languageEnglish (US)
Pages (from-to)1758-1766
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume147
Issue number6
DOIs
StatePublished - 2014

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Marfan Syndrome
Aortic Valve
Multicenter Studies
Aortic Valve Insufficiency
Morbidity
Reoperation
Proportional Hazards Models
Registries
Coronary Vessels
Survival Rate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Coselli, J. S., Volguina, I. V., Lemaire, S. A., Sundt, T. M., Connolly, H. M., Stephens, E. H., ... Miller, D. C. (2014). Early and 1-year outcomes of aortic root surgery in patients with Marfan syndrome: A prospective, multicenter, comparative study. Journal of Thoracic and Cardiovascular Surgery, 147(6), 1758-1766. https://doi.org/10.1016/j.jtcvs.2014.02.021

Early and 1-year outcomes of aortic root surgery in patients with Marfan syndrome : A prospective, multicenter, comparative study. / Coselli, Joseph S.; Volguina, Irina V.; Lemaire, Scott A.; Sundt, Thoralf M.; Connolly, Heidi M.; Stephens, Elizabeth H.; Schaff, Hartzell V; Milewicz, Dianna M.; Vricella, Luca A.; Dietz, Harry C.; Minard, Charles G.; Miller, D. Craig.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 147, No. 6, 2014, p. 1758-1766.

Research output: Contribution to journalArticle

Coselli, JS, Volguina, IV, Lemaire, SA, Sundt, TM, Connolly, HM, Stephens, EH, Schaff, HV, Milewicz, DM, Vricella, LA, Dietz, HC, Minard, CG & Miller, DC 2014, 'Early and 1-year outcomes of aortic root surgery in patients with Marfan syndrome: A prospective, multicenter, comparative study', Journal of Thoracic and Cardiovascular Surgery, vol. 147, no. 6, pp. 1758-1766. https://doi.org/10.1016/j.jtcvs.2014.02.021
Coselli, Joseph S. ; Volguina, Irina V. ; Lemaire, Scott A. ; Sundt, Thoralf M. ; Connolly, Heidi M. ; Stephens, Elizabeth H. ; Schaff, Hartzell V ; Milewicz, Dianna M. ; Vricella, Luca A. ; Dietz, Harry C. ; Minard, Charles G. ; Miller, D. Craig. / Early and 1-year outcomes of aortic root surgery in patients with Marfan syndrome : A prospective, multicenter, comparative study. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 147, No. 6. pp. 1758-1766.
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title = "Early and 1-year outcomes of aortic root surgery in patients with Marfan syndrome: A prospective, multicenter, comparative study",
abstract = "Objective To compare the 1-year results after aortic valve-sparing (AVS) or valve-replacing (AVR) aortic root replacement from a prospective, international registry of 316 patients with Marfan syndrome (MFS). Methods Patients underwent AVS (n = 239, 76{\%}) or AVR (n = 77, 24{\%}) aortic root replacement at 19 participating centers from 2005 to 2010. One-year follow-up data were complete for 312 patients (99{\%}), with imaging findings available for 293 (94{\%}). The time-to-events were compared between groups using Kaplan-Meier curves and Cox proportional hazards models. Results Two patients (0.6{\%}) - 1 in each group - died within 30 days. No significant differences were found in early major adverse valve-related events (MAVRE; P =.6). Two AVS patients required early reoperation for coronary artery complications. The 1-year survival rates were similar in the AVR (97{\%}) and AVS (98{\%}) groups; the procedure type was not significantly associated with any valve-related events. At 1 year and beyond, aortic regurgitation of at least moderate severity (≥2+) was present in 16 patients in the AVS group (7{\%}) but in no patients in the AVR group (P =.02). One AVS patient required late AVR. Conclusions AVS aortic root replacement was not associated with greater 30-day mortality or morbidity rates than AVR root replacement. At 1 year, no differences were found in survival, valve-related morbidity, or MAVRE between the AVS and AVR groups. Of concern, 7{\%} of AVS patients developed grade ≥2+ aortic regurgitation, emphasizing the importance of 5 to 10 years of follow-up to learn the long-term durability of AVS versus AVR root replacement in patients with MFS.",
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T1 - Early and 1-year outcomes of aortic root surgery in patients with Marfan syndrome

T2 - A prospective, multicenter, comparative study

AU - Coselli, Joseph S.

AU - Volguina, Irina V.

AU - Lemaire, Scott A.

AU - Sundt, Thoralf M.

AU - Connolly, Heidi M.

AU - Stephens, Elizabeth H.

AU - Schaff, Hartzell V

AU - Milewicz, Dianna M.

AU - Vricella, Luca A.

AU - Dietz, Harry C.

AU - Minard, Charles G.

AU - Miller, D. Craig

PY - 2014

Y1 - 2014

N2 - Objective To compare the 1-year results after aortic valve-sparing (AVS) or valve-replacing (AVR) aortic root replacement from a prospective, international registry of 316 patients with Marfan syndrome (MFS). Methods Patients underwent AVS (n = 239, 76%) or AVR (n = 77, 24%) aortic root replacement at 19 participating centers from 2005 to 2010. One-year follow-up data were complete for 312 patients (99%), with imaging findings available for 293 (94%). The time-to-events were compared between groups using Kaplan-Meier curves and Cox proportional hazards models. Results Two patients (0.6%) - 1 in each group - died within 30 days. No significant differences were found in early major adverse valve-related events (MAVRE; P =.6). Two AVS patients required early reoperation for coronary artery complications. The 1-year survival rates were similar in the AVR (97%) and AVS (98%) groups; the procedure type was not significantly associated with any valve-related events. At 1 year and beyond, aortic regurgitation of at least moderate severity (≥2+) was present in 16 patients in the AVS group (7%) but in no patients in the AVR group (P =.02). One AVS patient required late AVR. Conclusions AVS aortic root replacement was not associated with greater 30-day mortality or morbidity rates than AVR root replacement. At 1 year, no differences were found in survival, valve-related morbidity, or MAVRE between the AVS and AVR groups. Of concern, 7% of AVS patients developed grade ≥2+ aortic regurgitation, emphasizing the importance of 5 to 10 years of follow-up to learn the long-term durability of AVS versus AVR root replacement in patients with MFS.

AB - Objective To compare the 1-year results after aortic valve-sparing (AVS) or valve-replacing (AVR) aortic root replacement from a prospective, international registry of 316 patients with Marfan syndrome (MFS). Methods Patients underwent AVS (n = 239, 76%) or AVR (n = 77, 24%) aortic root replacement at 19 participating centers from 2005 to 2010. One-year follow-up data were complete for 312 patients (99%), with imaging findings available for 293 (94%). The time-to-events were compared between groups using Kaplan-Meier curves and Cox proportional hazards models. Results Two patients (0.6%) - 1 in each group - died within 30 days. No significant differences were found in early major adverse valve-related events (MAVRE; P =.6). Two AVS patients required early reoperation for coronary artery complications. The 1-year survival rates were similar in the AVR (97%) and AVS (98%) groups; the procedure type was not significantly associated with any valve-related events. At 1 year and beyond, aortic regurgitation of at least moderate severity (≥2+) was present in 16 patients in the AVS group (7%) but in no patients in the AVR group (P =.02). One AVS patient required late AVR. Conclusions AVS aortic root replacement was not associated with greater 30-day mortality or morbidity rates than AVR root replacement. At 1 year, no differences were found in survival, valve-related morbidity, or MAVRE between the AVS and AVR groups. Of concern, 7% of AVS patients developed grade ≥2+ aortic regurgitation, emphasizing the importance of 5 to 10 years of follow-up to learn the long-term durability of AVS versus AVR root replacement in patients with MFS.

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