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Muiño-Mosquera L, Cervi E, De Groote K, Dewals W, Fejzic Z, Kazamia K, Mathur S, Milleron O, Mir TS, Nielsen DG, Odermarsky M, Sabate-Rotes A, van der Hulst A, Valenzuela I, Jondeau G. Management of aortic disease in children with FBN1-related Marfan syndrome. Eur Heart J 2024; 45:4156-4169. [PMID: 39250726 PMCID: PMC11472455 DOI: 10.1093/eurheartj/ehae526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/14/2024] [Accepted: 07/31/2024] [Indexed: 09/11/2024] Open
Abstract
Marfan syndrome (MFS) is a hereditary connective tissue disorder with an estimated prevalence of 1:5000-1:10 000 individuals. It is a pleiotropic disease characterized by specific ocular, cardiovascular, and skeletal features. The most common cardiovascular complication is aortic root dilatation which untreated can lead to life-threatening aortic root dissection, mainly occurring in adult patients. Prompt diagnosis, appropriate follow-up, and timely treatment can prevent aortic events. Currently there are no specific recommendations for treatment of children with MFS, and management is greatly based on adult guidelines. Furthermore, due to the scarcity of studies including children, there is a lack of uniform treatment across different centres. This consensus document aims at bridging these gaps of knowledge. This work is a joint collaboration between the paediatric subgroup of the European Network of Vascular Diseases (VASCERN, Heritable Thoracic Aortic Disease Working Group) and the Association for European Paediatric and Congenital Cardiology (AEPC). A group of experts from 12 different centres and 8 different countries participated in this effort. This document reviews four main subjects, namely, (i) imaging of the aorta at diagnosis and follow-up, (ii) recommendations on medical treatment, (iii) recommendations on surgical treatment, and (iv) recommendations on sport participation.
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Affiliation(s)
- Laura Muiño-Mosquera
- Department of Paediatrics, division of Paediatric Cardiology, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Elena Cervi
- Inherited Cardiovascular Diseases Centre, Cardiology, Great Ormond Street Hospital, London, United Kingdom
| | - Katya De Groote
- Department of Paediatrics, division of Paediatric Cardiology, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Wendy Dewals
- Department of Paediatrics, division of Paediatric Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Zina Fejzic
- Department of Paediatrics, division of Paediatric Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kalliopi Kazamia
- Department of Paediatric Cardiology, Stockholm-Uppsala, Karolinska University Hospital, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska University Hospital, Stockholm, Sweden
| | - Sujeev Mathur
- Department of Cardiovascular Imaging, Guy’s and St Thomas Hospital, London, United Kingdom
| | - Olivier Milleron
- Centre de réference pour le syndrome de Marfan et apparentés, Department of Cardiology, Bichat Claude Bernard Hospital, Université Paris Cité, INSERM U1148, Paris, France
| | - Thomas S Mir
- Childrens Heart Centre, Paediatric Cardiology, University Clinics Hamburg, Hamburg, Germany
| | - Dorte G Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Anna Sabate-Rotes
- Department of Paediatric Cardiology, Hospital Vall D’Hebron, Barcelona, Spain
| | - Annelies van der Hulst
- Department of Paediatrics, Division of Paediatric Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Irene Valenzuela
- Department of Clinical and Molecular Genetics, Hospital Vall d’Hebron, Barcelona, Spain
| | - Guillaume Jondeau
- Centre de réference pour le syndrome de Marfan et apparentés, Department of Cardiology, Bichat Claude Bernard Hospital, Université Paris Cité, INSERM U1148, Paris, France
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Schizas N. Cusp repair during valve-sparing aortic root replacement with reimplantation. Repair or replace? Indian J Thorac Cardiovasc Surg 2024; 40:394-395. [PMID: 38681716 PMCID: PMC11045676 DOI: 10.1007/s12055-023-01675-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 05/01/2024] Open
Affiliation(s)
- Nikolaos Schizas
- National and Kapodistrian University, Mikras Asias 75, Athens, 11527 Greece
- 4th Cardiac Surgery Department, Hygeia Hospital, Marousi, Greece
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Zuo Y, Tan R, Qin C. Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis. J Cardiothorac Surg 2023; 18:206. [PMID: 37400892 DOI: 10.1186/s13019-023-02329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/29/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Valve-sparing aortic root replacement (VSARR) is a safe and effective surgical procedure to treat aortic root aneurysm. This meta-analysis aimed to investigate how this procedure might differ in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). DESIGN Meta-analysis with meta-regression and systematic review. SETTING Systematic search in the following databases: PubMed, Cochrane Central Register of Controlled Trials, and Embase. INTERVENTIONS All observational studies of VSARR in patients with BAV or TAV were included in our study. Studies were included without any restrictions on language or publication date. A trial sequential analysis and a post-hoc meta-regression was performed on the main outcomes. RESULT Eleven articles met the inclusion criteria. A total of 1138 patients in BAV group, and 2125 patients in TAV group. No significant differences in gender and age were observed between BAV and TAV patients. BAV and TAV patients showed no differences in in-hospital mortality rate [0.00% vs. 1.93%; RR (95% CI) 0.33 (0.09, 1.26), I2 = 0%, P = 0.11] and the rate of in-hospital reoperation [5.64% vs. 5.99%; RR (95% CI) 1.01(0.59, 1.73), I2 = 33%, P = 0.98]. The overall long-term mortality rate of BAV patients was better than that of TAV patients [1.63% vs. 8.15%; RR (95% CI) 0.34 (0.13, 0.86), I2 = 0%, P = 0.02]. During the follow-up observation period, patients in TAV group showed small but no statistic advantage in 3-year, 5-year, and over 10-year incidences of reintervention. Regarding the secondary endpoints, the two groups showed similar aortic cross-clamping time and total cardiopulmonary bypass time. CONCLUSION The VSARR techniques yielded similar clinical outcomes in both BAV and TAV patients. Although patients with BAV might have a higher incidence of reinterventions after initial VSARR, it is still a safe and effective approach to treat aortic root dilation with or without aortic valve insufficiency. TAV patients showed small but no statistic advantage in long-term (over 10 years) reintervention rate, which means, patients with BAV may face a higher risk of reintervention in the clinic.
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Affiliation(s)
- Yiding Zuo
- Department of Anesthesia, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ruixi Tan
- Department of Anesthesia, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Chaoyi Qin
- Department of Cardiovascular Surgery and Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, 37th Guoxue Road, Chengdu, 610041, China.
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Schäfers HJ. Commentary: Thirty years of valve preserving surgery—are all questions answered? J Thorac Cardiovasc Surg 2021; 161:903-904. [DOI: 10.1016/j.jtcvs.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 01/12/2023]
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De Martino A, Pratali S, Carrai P, Petruccelli S, De Simone P, Bortolotti U. Aortic valve-sparing procedure-a durable choice in liver transplantation recipient. Gen Thorac Cardiovasc Surg 2020; 69:343-345. [PMID: 32656707 PMCID: PMC7868313 DOI: 10.1007/s11748-020-01434-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/04/2020] [Indexed: 11/25/2022]
Abstract
A 44-year old man with aortic regurgitation and aneurysm of the ascending aorta underwent an aortic valve-sparing procedure as a durable treatment before liver transplantation. Since patients with chronic liver failure are at high risk of hemorrhagic complications at time of major surgery, while management of warfarin administration may still represent a concern, the choice of a cardiac procedure which avoids any anticoagulant treatment appeared justified.
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Affiliation(s)
- Andrea De Martino
- Sezione Autonoma Di Cardiochirurgia Universitaria, Section of Cardiac Surgery, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | - Stefano Pratali
- Sezione Autonoma Di Cardiochirurgia Universitaria, Section of Cardiac Surgery, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | - Paola Carrai
- Liver Transplant Surgery Unit, Pisa University Hospital, Pisa, Italy
| | | | - Paolo De Simone
- Liver Transplant Surgery Unit, Pisa University Hospital, Pisa, Italy
| | - Uberto Bortolotti
- Sezione Autonoma Di Cardiochirurgia Universitaria, Section of Cardiac Surgery, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy.
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Burgstaller JM, Held U, Mosbahi S, Stak D, Steurer J, Eckstein F, Berdajs DA. A systemic review and meta-analysis: long-term results of the Bentall versus the David procedure in patients with Marfan syndrome. Eur J Cardiothorac Surg 2018; 54:411-419. [DOI: 10.1093/ejcts/ezy158] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/03/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jakob M Burgstaller
- Horten Center for Patient-Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Ulrike Held
- Horten Center for Patient-Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Selim Mosbahi
- Department of General Surgery, County Hospital Freiburg, Freiburg im Breisgau, Switzerland
| | - Dushaj Stak
- Department of Cardiac Surgery, Triemli City Hospital, Zurich, Switzerland
| | - Johann Steurer
- Horten Center for Patient-Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland
| | - Friedrich Eckstein
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Denis A Berdajs
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
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Jahangiri M, Leigh B, Cameron D. External aortic root support: a viable alternative treatment option? Consent and duty of candour. Eur J Cardiothorac Surg 2017; 51:1020. [PMID: 28329349 DOI: 10.1093/ejcts/ezw440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/16/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marjan Jahangiri
- Department of Cardiothoracic Surgery, St. George's Hospital, University of London, London, UK
| | | | - Duke Cameron
- Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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Berdajs D, Mosbahi S, Forro Z, Burki M, von Segesser LK. Aortic root haemodynamics following David procedure: numerical analysis of 3-dimensional haemodynamics. Eur J Cardiothorac Surg 2016; 49:1588-98. [DOI: 10.1093/ejcts/ezv427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/09/2015] [Indexed: 11/13/2022] Open
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Berdajs DA. Aortic root morphology: a paradigm for successful reconstruction. Interact Cardiovasc Thorac Surg 2015; 22:85-91. [DOI: 10.1093/icvts/ivv290] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/10/2015] [Indexed: 11/13/2022] Open
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Mignosa C, Mariani C, Deste W, Felis S, Di Stefano S, Giuffrida A, Rubino AS. Long-Term Hemodynamic Performance of the Aortic Valve After David I: An Echocardiographic Study. Semin Thorac Cardiovasc Surg 2015; 27:257-63. [DOI: 10.1053/j.semtcvs.2015.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 11/11/2022]
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