Endovascular treatment of type B dissection in patients with Marfan syndrome: mid-term outcomes and aortic remodeling.

OBJECTIVES: To evaluate the mid-term outcomes, and the aortic remodeling in Marfan syndrome (MFS) patients with type B dissection that were treated with endovascular repair. BACKGROUND: MFS is a relative contraindication to thoracic endovascular aortic repair (TEVAR). Mid-term aortic outcomes data in MFS after TEVAR are limited, and the occurrence of late events remains unclear. METHODS: Of 89 patients that underwent TEVAR between September 2002 and February 2011, 10 patients with mid-term follow-up fulfilled the Ghent criteria for MFS and complicated type B dissection. High risk for open surgery was documented in 90%. RESULTS: The mean age was 35.1 ± 9.4 years and all patients presented with acute aortic syndrome complicating a chronic type B dissection (DeBakey type IIIb). Five patients underwent a Bentall surgical procedure previous to endovascular repair, and in four patients initial TEVAR was followed by surgery of the ascending aorta. Treatment was limited to endovascular repair in only one patient. In-hospital mortality was 10%. At a mean follow-up of 59.6 ± 38.9 months, the cumulated mortality was of 20% and late mortality 11.1%. The rate of secondary endoleak was 44.4%, and late reintervention of 33.3%. Survival freedom from cardiovascular death at 8 years was 80.0%, and positive remodeling was documented in 37.5% of patients. CONCLUSIONS: Our results suggest that TEVAR is feasible, safe, and associated with a high reintervention rate and reduced rate of positive aortic remodeling in patients with Marfan syndrome. Survival at 8 years was comparable to contemporary series of open repair.

[Results of replacement of ascending aorta, and aortic valve with reimplantation of coronary arteries]. / Resultados da substituição da aorta ascendente e valva aórtica com reimplante de artérias coronárias.

PURPOSE: To analyse a 10-year experience with the Bentall and De Bono technique for surgical treatment of aneurysms of ascending aorta. PATIENTS AND METHODS: From January 1980 to December 1989, the Bentall and De Bono technique was employed in 38 patients. Twenty-two patients had aneurysm of ascending aorta with aortic insufficiency; 14 had chronic aortic dissections. Four patients were operated on previously by other techniques. RESULTS: The immediate mortality was 5.2%; one patient due to low-output syndrome and one had neurological complications. Five patients (13.1%) died late postoperatively. The surviving 31 patients were followed up from two to 72 months (mean 25). Of these, 29 (93.5%) were in functional class I and two in class II. Sixteen patients had late evaluation by one or more of the following methods: digital angiography, chest computerized tomography, echocardiography, or conventional angiography, 6 to 60 (mean 33) months after operation. All of them had good conditions of composite valve graft and coronary artery reattachment. The immediate and late results were similar in patients with aneurysms and aortic dissections. CONCLUSION: The aortic valve and aortic ascending portion replacement with reimplantation of coronary arteries is of low mortality and fairly good late outcome.

Resultados da substituiçäo da aorta ascendente e valva aórtica com reimplante de artérias coronárias / Results of replacement of ascending aorta and aortic valve with reimplantation of coronary arteries

Avaliar a técnica de substituiçäo da valva aórtica e aorta ascendente com reimplante de artérias coronárias no tratamento cirúrgico de aneurismas da aorta ascendente. Entre janeiro de 1980 e dezembro de 1989, 38 paciente sforam operados por essa técnica. Vinte e dois pacientes eram portadores de aneurisma da aorta ascendente com insuficiência da valva aórtica; 14 de dissecçäo crônica de aorta e dois foram operados por dissecçäo na fase aguda. Quatro doentes haviam sido operados previamente por outras técnicas. A mortalidade imediata foi de 5,2%; um paciente por baixo débito e outro por complicaçäo neurológica. Cinco doentes (13,1%) morreram tardiamente, dos quais dois subitamente. O seguimento dos 31 sobreviventes variou de 2 a 72 meses com média de 25; (29(93,5%) estavam na classe funcional I e dois em classe II. Dezesseis pacientes foram submetidos a reestudo por um ou mais dos seguintes métodos: angiografia digital, tomografia computadorizada, ecocardiograma ou angiografia convencional, de 6 a 60 meses após a operaçäo, com média de 33 meses. Todos apresentavam boas condiçöes dos óstios coronários e das próteses. Os resultados imediatos e tardios foram semelhantes nos pacientes operados por dissecçäo ou aneurisma verdadeiro. A técnica de substituiçäo de valva aórtica e aorta ascendente com reimplante de artérias coronárias apresenta baixa mortalidade e bons resultados tardios

Purpose - To analyse a 10-year experience with the Bentall and De Bono technique for surgical treatment of aneurysms of ascending aorta. Patients and Methods - From January 1980 to December 1989, the Bentall and De Bono technique was employed in 38 patients. Twenty-two patients had aneurysm of ascending aorta with aortic insufficiency; 14 had chronic aortic dissections. Four patients were operated on previously by other techniques. Results The immediate mortality was 5.2%; one patient due to low-output syndrome and one had neurological complications. Five patients (13.1%) died late postoperatively. The surviving 31 patients were followed up from two to 72 months (mean 25). Of these, 29 (93.5%) were in functional class I and two in class II. Sixteen patients had late evaluation by one or more of the following methods: digital ang iography, ches t computerized tomography, echocardiography, or conventional angiography, 6 to 60 (mean 33) months after operation. All of them had good conditions of composite valve graft and coronary artery reattachment. The immediate and late results were similar in patients with aneurysms and aortic dissections. Conclusion - The aortic valve and aortic ascending portion replacement with reimplantation of coronary arteries is of low mortality and fairly good late outcome