Factors Influencing Prognosis in Patients With Marfan Syndrome After Aortic Surgery

• Published in: Journal of cardiothoracic and vascular anesthesia 2011-08, Vol.25 (4), p.625-631
• Main Authors: Gao, Linggen, MD, Zhou, Xianliang, MD, Zhang, Lin, MD, Wen, Dan, MD, Chang, Qian, MD, Wu, Yongbo, MD, Sun, Lizhong, MD, Hui, Rutai, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anesthesia & Perioperative Care; Aneurysm, Dissecting - surgery; aortic aneurysm; Aortic Aneurysm - surgery; blood pressure; Body Mass Index; Child; Critical Care; Female; Humans; Male; Marfan syndrome; Marfan Syndrome - mortality; Marfan Syndrome - surgery; Middle Aged; Prognosis; Proportional Hazards Models; Retrospective Studies; smoking; surgical treatment; Survival Rate
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2010.11.019

Objective Aortic aneurysm formation leading eventually to aortic rupture or dissection in early adult life is a fatal outcome of Marfan syndrome (MFS). Advances in the treatment of the syndrome have improved prognosis, but the long-term reoperation rate is still high. It remains unknown which factors influence the long-term prognosis, including the reoperation and mortality rates, in surgically treated Chinese patients with MFS. The authors studied 125 such patients to investigate factors influencing prognosis after aortic surgery. Design A retrospective clinical investigation. Setting An academic medical center. Subjects One hundred twenty-five Marfan patients who had undergone aortic surgery. Interventions None. Measurements and Main Results The indications for aortic surgery were aortic aneurysm and/or dissection in the 125 Marfan patients. The most commonly performed procedure was the Bentall in 92 patients. Sixteen patients underwent total arch replacement combined with stented elephant trunk implantation. Ten patients underwent the David procedure. Overall in-hospital and 30-day mortality rate was 1.6%. The survival rate was 97.5%, 91.4%, and 74.2% at 1, 5, and 10 years after surgery, respectively. The reoperation rate was 2.5%, 12.9%, and 32.9% at 1, 5, and 10 years after surgery, respectively. Multivariate analysis revealed that increased systolic blood pressure (Sys BP) was the predictor of death ( p < 0.05), and body mass index and smoking were significant predictors of reoperation ( p < 0.05). Conclusions The present findings report the factors influencing the prognosis of Chinese patients with MFS after aortic surgical procedures. Managing these risk factors may enable health care professionals to improve the prognosis of MFS patients after aortic surgical procedures.