Stent graft repair of descending aortic dissection in patients with Marfan syndrome: An effective alternative to open reoperation?
Received 6 December 2008; received in revised form 9 February 2009; accepted 8 March 2009. published online 13 May 2009.
Objective
Aneurysms or dissections can involve multiple aortic segments in patients with Marfan syndrome, requiring staged replacement of the entire aorta. The optimal treatment of descending aortic dissection in these patients is a major challenge. We investigated the feasibility and outcomes of endovascular repair of the descending aorta in patients already submitted to open aortic root/arch surgery.
Methods
From March 1998 to July 2008, 12 patients (10 male and 2 female patients; mean age, 37.8 ± 11.6 years) affected by Marfan syndrome underwent endovascular treatment for dissection of the descending aorta after previous open aortic root/arch surgery. Stent graft procedures were performed urgently in 5 patients and electively in 7 patients.
Results
Neither in-hospital deaths nor perioperative paraplegia or stroke occurred. Follow-up (median, 31 months; range, 3–57 months) was 100% complete. One patient needed surgical conversion for persistent type I endoleak, leading to false lumen expansion 3 months after endovascular repair. Extension of the dissection occurred in 2 patients 1 month and 2 years after the procedure, respectively. No late death or aortic rupture was observed.
Conclusions
Endovascular repair of the dissected descending thoracic aorta can be performed in patients with Marfan syndrome with a low risk of death or major complications. In case of staged procedures, stent graft treatment can be considered a possible alternative to open reoperation. Long-term durability remains to be determined.
aCardiac Surgery Unit, Cardiothoracovascular Department, University Hospital S. Orsola, Bologna, Italy
bCardiovascular Radiology Unit, Cardiothoracovascular Department, University Hospital S. Orsola, Bologna, Italy
Address for reprints: Rossella Fattori, MD, Cardiothoracovascular Department (Pad 21), University Hospital S. Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy.
Disclosures: Rossella Fattori, MD, reports receiving consulting fees, lecture fees, or both from Medtronic.
ABSTRACT