Age at elective aortic root surgery in marfan syndrome: does medication matter? a study by the European reference network VASCERN

Background/Introduction Current guidelines recommend beta-blockers (BB) and/or angiotensin II receptor blockers (ARB) in Marfan syndrome (MFS), to postpone critical aortic root dilatation (1, 2). However, it is unknown whether patients on medication subsequently undergo elective aortic root surgery at an older age. Purpose To evaluate age at time of elective aortic root surgery for MFS in relation to medication use. Methods In this retrospective multicenter study in 7 Marfan syndrome referral centers in 4 countries (The Netherlands, France, Spain, and Belgium), electronic patient records were studied. Patients who had at least three years of follow-up prior to elective aortic root surgery without any changes in medication, and no history of aortic dissection before surgery, were eligible for participation. Age at the time of surgery was compared between treatment groups using a one-way ANOVA test, and categorical variables were compared using Fisher Exact Tests. Results A total of 330 patients (118 (36%) female) underwent elective aortic root surgery between 1992 and 2024 and fulfilled the inclusion criteria. The majority of the patients used cardiac medication prior to surgery (n=256, (77%)). BB were used in 194 (59%) patients, ARB were used in 27 (8%) patients, a combination of BB and ARB was used in 27 (8%) and other antihypertensive medication was used in 8 (2%) patients. No difference in mean age (years) at time of surgery was observed between medication categories (BB: 35 ± 13, ARB: 38 ± 15, BB & ARB: 37 ± 16, other cardiovascular medication: 40 ± 20, none: 37 ± 12, p = 0.769). Mean aortic root diameter at time of surgery was 50 ± 6 mm and did not differ between medication categories (p=0.255). Presence of haploinsufficient FBN1 mutations, male sex or family history of aortic dissection were not different between medication categories. However, mean arterial blood pressure prior to surgery (MAP),(mmHg) differed between treatment categories (BB: 88 ± 10, ARB: 94 ± 10, ARB&BB: 85 ± 10, Other: 89 ± 6, no medication: 93 ± 11, p<0.001) Conclusion(s) Medication use in the three years preceding elective aortic root surgery was not associated with the average age at the time of surgery in a historical cohort of MFS patients.