The Journal of Thoracic and Cardiovascular Surgery
Adult: AortaRisk profile and operative outcomes in patients with and without Marfan syndrome undergoing thoracoabdominal aortic aneurysm repair
Graphical abstract
Section snippets
Methods
The departmental aortic surgery database was reviewed to identify all consecutive patients who underwent first-time open TAAA repair between May 1997 and April 2022. This prospectively maintained database was queried for pre-, intra- and postoperative details. The database is prospectively maintained by chart review. A review of the collected patients' health information was conducted and missing or outdated data were retrieved or updated through review of medical records. This study was
Results
A total of 684 patients underwent open TAAA repair during the study period. Of these, 90 (13.1%) had Marfan syndrome, whereas 594 (86.9%) did not. Marfan patients were younger (46 years; range, 36-56 years vs 69 years; range, 61-76 years; P < .001), had lower ejection fraction (P = .03), had more frequently undergone previous heart surgery (85.6% vs 52.9%; P < .001), including proximal aortic graft implantation (43.3% vs 14.1%; P < .001) and aortic valve replacement (35.6% vs 4.0%; P < .001).
Discussion
Outcomes of open surgical repair of TAAA have significantly improved during the past few decades due to the development and improvement in preoperative risk assessment, intraoperative techniques, and postoperative intensive care. This includes aggressive intraoperative approaches like neuroprotective strategies, intercostal reimplantation,19 visceral and renal perfusion,20,21 left heart bypass,22 and hypothermic circulatory arrest.4 Despite all of these improvements in managing patients with
Conclusions
Open repair of TAAA in patients with Marfan syndrome can be performed with similar operative outcomes to patients without Marfan syndrome despite the association with higher risk aneurysm features in Marfan patients and cardiovascular risk factors in patients without Marfan syndrome. Due to the vastly different risk profiles, operative and perioperative strategies must differ and surgeons need to tailor the operation to the specific needs of each patient to optimize outcomes. By mitigating the
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Drs Lau and Soletti contributed equally to this article.
IRB#: 1607017424 (approved January 9, 2022), need for informed consent waived.