• J. Thorac. Cardiovasc. Surg. · Jan 2025

    Natural History of the Distal Aorta Following Elective Root Replacement in Patients with Marfan Syndrome.

    • Arjune S Dhanekula, Rachel Flodin, Palcah Shibale, Joseph Volk, Thoetphum Benyakorn, Scott DeRoo, Sherene Shalhub, and Christopher R Burke.
    • Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash. Electronic address: adhaneku@uw.edu.
    • J. Thorac. Cardiovasc. Surg. 2025 Jan 1; 169 (1): 4958.e549-58.e5.

    ObjectiveIt is unclear if the addition of a prophylactic arch operation is beneficial at the time of root replacement in patients with Marfan syndrome (MFS). This project aims to understand the fate of the distal aorta following elective root replacement in patients with MFS.MethodsBetween 2000 and 2019, 124 adult patients with MFS were identified as having undergone elective aortic root replacement with a clamped distal aortic anastomosis during their lifetime. Serial axial imaging was analyzed. The primary outcome was a composite of subsequent type B aortic dissection (TBAD), aneurysmal degeneration (>4 cm), and aortic reintervention. Secondary outcomes included subsequent TBAD and mortality.ResultsMean age at root replacement was 33.3 years. Median follow-up was 11.3 years. Thirty-one patients (25%) experienced the primary outcome, with no survival difference (P = .9). The crossclamp and aortic cannulation sites were stable (growth rate, 0.33 mm/year), and 2 patients (1.6%) required reintervention there. Twenty-three patients (19.8%) experienced subsequent TBAD. Patients with TBAD had a higher rate of distal degeneration (P < .001), but no significant change in survival (P = .2). Preoperative hypertension (odds ratio, 3.96; P < .05) and younger age at root replacement (odds ratio, 1.05; P < .05) increased the risk of TBAD, based on regression analysis.ConclusionsThe distal aorta (including the clamp and cannulation site) overall appears stable in patients with MFS following elective root replacement without prophylactic arch operation. Development of TBAD seems to be the primary driver of distal degeneration. Factors associated with TBAD development included hypertension, underscoring the importance of strict blood pressure control in these patients.Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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