Valve-sparing aortic root replacement in patients with Marfan syndrome: a systematic review

Aim. To analyze the literature about the results of valve-sparing operations in aortic root surgery in patients with Marfan syndrome. Methods. A comprehensive search included four databases: Pubmed, Embase, Cochrane Library, and Web of Science. Articles for analysis were selected according to the methods presented in the PRISMA 2020 guidelines. Results. The final systematic review included 19 studies and 4 meta-analyses. The findings showed that 30-day and hospital mortality rates did not exceed 2.08%. The incidence of thromboembolism over a 15-year period was 4.1 ± 2.0%. The mean rate of infective endocarditis was 0.25%. Freedom from severe aortic insufficiency 8 years after surgery was 95.2 ± 3.3%. Freedom from reoperation at 8 and 10 years was 97%. Long-term mortality was ≤ 10.57%. The 5-, 10-year survival rates were 95.4 and 84.2% respectively.Conclusion. Valve-sparing operations are more beneficial than valved conduits in patients with Marfan syndrome in the short and long-term periods. Thromboembolism, endocarditis, and bleeding were significantly more common in patients with valved conduits in the long-term period. Received 7 February 2022. Revised 16 May 2022. Accepted 18 May 2022. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: A.U. Normuradov, R.M. lsaev, M.A. Soborov, A.I. Ropova, V.D. ReiterDrafting the article: A.U. Normuradov, R.M. lsaev, A.I. Ropova, V.D. ReiterCritical revision of the article: A.U. Normuradov, R.M. lsaevFinal approval of the version to be published: R.N. Komarov, A.U. Normuradov, R.M. Isaev, M.A. Soborov, A.I. Ropova, V.D. Reiter