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Schoenhoff FS, Jungi S, Czerny M, Roost E, Reineke D, Matyas G, Steinmann B, Schmidli J, Kadner A, Carrel T. Acute Aortic Dissection Determines the Fate of Initially Untreated Aortic Segments in Marfan Syndrome. Circulation 2013; 127:1569-75. [DOI: 10.1161/circulationaha.113.001457] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The aim of the current study was to investigate incidence and causes of surgical interventions in primarily nontreated aortic segments after previous aortic repair in patients with Marfan syndrome.
Methods and Results—
Retrospective analysis of 86 consecutive Marfan syndrome patients fulfilling Ghent criteria that underwent 136 aortic surgeries and were followed at this institution in the past 15 years. Mean follow-up was 8.8±6.8 y. Thirty-day, 6-month, 1-year, and overall mortality was 3.5%, 5.8%, 7.0%, and 12.8%, respectively. Ninety-two percent of patients initially presented with aortic root, ascending aortic or arch lesions, whereas 8% presented with descending aortic or thoraco-abdominal lesions. Primary presentation was acute aortic dissection (AAD) in 36% (77% type A, 23% type B) and aneurismal disease in 64%. Secondary complete arch replacement had to be performed in only 6% of patients without AAD, but in 36% with AAD (
P
=0.0005). In patients without AAD, 11% required surgery on primarily nontreated aortic segments (5 of 6 patients experienced type B dissection during follow-up), whereas in patients after AAD, 48% underwent surgery of initially nontreated aortic segments (42% of patients with type A and 86% of those with type B dissection;
P
=0.0002).
Conclusions—
The need for surgery in primarily nontreated aortic segments is precipitated by an initial presentation with AAD. Early elective surgery is associated with low mortality and reintervention rates. Type B dissection in patients with Marfan syndrome is associated with a high need for extensive aortic repair, even if the dissection is being considered uncomplicated by conventional criteria.
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Affiliation(s)
- Florian S. Schoenhoff
- From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children’s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G
| | - Silvan Jungi
- From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children’s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G
| | - Martin Czerny
- From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children’s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G
| | - Eva Roost
- From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children’s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G
| | - David Reineke
- From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children’s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G
| | - Gabor Matyas
- From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children’s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G
| | - Beat Steinmann
- From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children’s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G
| | - Juerg Schmidli
- From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children’s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G
| | - Alexander Kadner
- From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children’s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G
| | - Thierry Carrel
- From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children’s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G
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