Abstract 16417: Influence of Proximal Aortic Repair on the Incidence of Type B Dissection in Patients With Marfan Syndrome
Objective: Elective aortic root surgery improves survival in patients with Marfan syndrome (MFS) by preventing type A dissection. Aim of the study was to evaluate the influence of proximal aortic repair on the incidence of type B dissection in MFS patients Patients: Retrospective analysis of 107 consecutive MFS patients fulfilling Ghent criteria that underwent 176 aortic surgeries and were followed at this institution since 1995.
Results: Mean follow-up was 9.4±7y. Initial presentation was acute aortic dissection in 34% of patients (75% type A, 25% type B) and aneurismal disease in 66%. Incidence of type B dissection was 23% including 4% of patients presenting with de novo type B dissection after successful exclusion of type A aortic dissection and 2% of patients that experienced retrograde type A dissection during follow-up. Only 2% of patients initially presented with complicated type B dissection. All cause 30-day, 6-months, 1-year and late mortality in the type B dissection group was 0%, 4%, 4% and 20% compared to 3.7%, 5.6%, 6.5% and 11.2%, respectively, in the entire cohort. Maximum aortic diameter at onset of pain was 36±8mm and 62±10mm at the time of surgery. Average growth rate was 1.9±2mm/month after onset of pain. Interestingly, incidence of type B dissection in the subgroup of patients that previously underwent elective proximal aortic repair did not differ compared to the overall population (17% vs. 23%, p=0.4). Furthermore, maximum aortic diameter at onset of pain (37±5mm vs. 35±10mm, p=0.5) as well as average growth rate after onset of pain (2.6±2.6mm/month vs. 1.8±1.7mm/month, p=0.4) did not differ significantly between patients initially presenting with type B dissection compared to those after proximal aortic repair. There was no difference in the need for interventions on the distal aorta in the subgroup of patients that suffered from type B dissection after proximal repair (70% vs. 80%; p=1.0).
Conclusion: Elective aortic root surgery does not trigger nor prevent type B dissection. Patients after elective aortic root surgery carry the same risk to develop type B dissection than the overall MFS population. The current data therefore suggests that type A and type B dissections in MFS patients are distinct entities.
- © 2013 by American Heart Association, Inc.