Patient-tailored aortic root repair in adult marfanoid patients: Surgical considerations and outcomes

Abstract Objectives The aim of the study was to evaluate operative and functional results after individual, patient-tailored aortic root repair in marfanoid patients. Methods Among 518 patients operated on between 2002 and January 2016, using patient-tailored aortic root repair with isolated sinus replacement were 42 patients fulfilling the original Ghent criteria. None/trivial, mild, moderate, and severe insufficiency grades were presented in 5, 16, 10, and 11 patients, respectively. Results The repair was adjusted to the existing aortic annulus diameter. Replacement of 1, 2, or 3 sinuses of Valsalva was performed in 1, 14, and 27 patients. Concomitant cusp repair was performed in 17 patients (40.5%), and 10 patients (23.8%) underwent arch repair (total in 3). All patients survived surgery, and the follow-up (mean, 6.1±3.1; range, 0.8-14.2 years) was 100% completed. No patient revealed change of the form or size of the aortic neo-root, especially, the size of aortic annulus and sino-tubular junction during the follow-up time. No or trivial/mild insufficiency was presented in 22 and 18 patients, respectively, while another 2 patients demonstrating recurrent aortic insufficiency caused by cusp pathology underwent aortic valve replacement 43 and 66 months after primary surgery, respectively. Thus, the estimated survival free from aortic valve/root re-operation for any reason at 5 and 8 years was 96.8±3.2% and 91.4±6.0%, respectively. Conclusions Patient-tailored root repair using isolated sinus replacement is an effective and durable method of valve-sparing repair in selected marfanoid patients with a satisfactory quality of aortic cusps, which seems to be decisive for long-term valve function.