Abstract 13558: The Additive Effect of RAAS Blockade in Marfan Syndrome Patients after Bentall Operation
Background In Marfan syndrome (MFS) patients, prophylactic aortic operation and β-blocker reduced mortality. Recent studies showed Renin-Angiotensin-Aldosterone System (RAAS) blockade reduces aortic dilatation in mouse. We evaluated the effect of RAAS blockade concomitant with β -blocker in MFS patients with aortopathy. Methods We reviewed MFS patients diagnosed with Ghent criteria and who underwent Bentall operation from Jan 1984 to Jan 2011. All were prescribed β -blocker before and after operation indefinitely. We compared composite endpoint including mortality, new aortic dissection, reoperation due to progression of aneurysm, dissection or regurgitation between the patients without (Group 1, n=27) and with RAAS blockade (Group 2, n=63). Aortic diameter growth rate was calculated by dividing the diameter change on CT scan taken immediate post-operation and the latest one by the interval. Diameter was measured at descending thoracic aorta and abdominal aorta renal artery ostium level. Results Mean follow up period was 82±60 months. . There was no difference in clinical characteristics including mean systolic blood pressure and heart rate, cardiovascular risk factors and echocardiographic parameters before the operation except for age (32.8±10.3 vs 42.2±15.2, p=0.001). In group 1, 2 (7%) death, 5 (19%) new dissection and 7 (26%) re-operation occurred. In group 2, 3 (5%) death, 2 (3%) new dissection and 3 (5%) re-operation occurred. Kaplan-Meier plot showed better survival free from endpoint in Group 2 (Fig. 1). After adjustment for age, smoking, aortic dissection and sinus of valsalva diameter, RAAS blockade reduced the risk for endpoint (HR 0.36, 95% CI 0.13-0.94, p=0.04). Mean diameter change of DTA was 2.7±2.2 vs 1.1±0.8 (p=0.008) and abdominal aorta was 2.5±1.5 vs 1.0±0.9 (p=0.001) in Group 1 and 2, respectively. Conclusions RAAS blockade in addition to β-blocker in MFS after bentall operation reduced aortic dilatation and composite endpoint.
- © 2012 by American Heart Association, Inc.