Valve-sparing aortic root replacement in patients with Marfan syndrome—the Homburg experience

Aortic root dilatation occurs in most patients with Marfan syndrome with secondary valve failure or aortic complications being frequent consequences (1). The traditional surgical approach has been composite replacement of aortic valve and root, first described in the 1960s (2). Since the advent of valve-preserving aortic surgery, different techniques (3,4) have also been applied to Marfan patients. Generally they have resulted in good stability and a low incidence of complications (5-8). In some series, valve reimplantation has resulted in better valve stability at 15 years compared to root remodeling (5,7). This might be due to the fact that this technique—different from remodeling—addresses annular dilatation. In our own clinical experience, both forms of valve preserving root replacement have led to comparable results (8). As root remodeling has been shown to result in more physiological hemodynamics (9), we have become more liberal to use this approach with time. Beginning in 2004, intraoperative measurement of effective height (10) led to better recognition and more objective treatment of cusp prolapse. Starting 2009 a suture annuloplasty (11) was added to root remodeling in the presence of basal dilatation. In the present study, we examined the results now reaching 22 years of follow-up. The investigation was based on data collected prospectively and analyzed retrospectively, primary endpoints were freedom from reoperation and from AR≥II.