Original research

Prophylactic aortic root replacement on Marfan patients undergoing mitral valve repair

A. Kalangos, S.M. Cherian, J. Jolou, J.-C. Pache, H. Muller, P.O. Myers, M. Cikirikcioglu 

Geneva University Hospitals, Switzerland 

Significant mitral regurgitation (MR) could be the first manifestation in Marfan syndrome, even before the onset of aortic dilatation or aortic regurgitation (AR).
The aim – to analyse the role of simultaneous prophylactic aortic root replacement in Marfan patients presenting primarily with MR, undergoing mitral valve repair.
Materials and methods. A 4-year (2007 to 2010) retrospective analysis of a single surgeon’s experience included 13 Marfan patients (11 males, 2 females) aged between 12 to 60 years (mean 40.3). Pre-operative MR was grade III or more in all patients. Mechanisms of MR were anterior leaflet prolapse in 2 patients, and bi-leaflet prolapse in 11. All patients underwent mitral annuloplasty using a biodegradable intra-annular ring along with other mitral valve repair techniques. No patient had significant pre-operative AR, however, the aortic root diameter was greater than the physiologic range for their corresponding body surface area, hence, all patients underwent simultaneous prophylactic valve sparing aortic root replacement. Follow-up was complete in all patients, ranging from 1 to 4 years (mean 2.4).
Results. Post-operative MR at 6 months was grade 0 in 8 patients, and grade 1 in 5. No further progression was seen in any of the patients during the follow-up period. No progression in AR or aortic root complications were noted in any of the patients. There were no post-operative deaths.
Conclusions. Marfan patients with mitral regurgitation can be successfully repaired, with good short-term results. In patients with an aortic root diameter greater than their normal physiologic range, simultaneous prophylactic aortic root replacement is safe and effective in preventing complications associated with the disease.
Key words: Marfan’s syndrome, mitral regurgitation, aortic aneurysm.