PMID- 26876340 OWN - NLM STAT- MEDLINE DCOM- 20170327 LR - 20221207 IS - 1552-6259 (Electronic) IS - 0003-4975 (Linking) VI - 101 IP - 6 DP - 2016 Jun TI - Results of Open Surgical Repair in Patients With Marfan Syndrome and Distal Aortic Dissection. PG - 2193-201 LID - S0003-4975(15)01847-0 [pii] LID - 10.1016/j.athoracsur.2015.11.008 [doi] AB - BACKGROUND: In patients with Marfan syndrome (MFS), distal aortic dissection can necessitate thoracoabdominal aortic aneurysm (TAAA) repair in survivors of acute DeBakey type I dissection and those with DeBakey type III dissection. We examined outcomes of surgical repair of TAAA in patients with MFS with distal aortic dissection. METHODS: Data were analyzed for 127 consecutive TAAA repairs performed between January 2004 and June 2014 in patients with MFS and distal aortic dissection-DeBakey types I (n = 73) and III (n = 54). The median time from dissection onset to TAAA repair was 5.2 years (interquartile range [IQR]: 2.1 to 9.8 years) for the overall group and was longer in patients with DeBakey I (6.5 years, IQR: 3.5 to 13.9 years) than patients with DeBakey III (2.9 years, IQR: 0.6 to 6.0 years, p < 0.001). Eleven patients (9%) had acute or subacute dissection at the time of repair. Sixty-six patients (52%) underwent Crawford extent II TAAA repair. A composite end point, adverse event, was defined as operative death or permanent stroke, renal failure, paraplegia, or paraparesis. RESULTS: Eight patients had adverse events (6%), including 5 operative deaths (4%). There was no permanent stroke and 1 case each of permanent paraplegia and paraparesis. At discharge, 2 early survivors (2%) had renal failure. Extent II repairs did not have substantially different outcomes from other repairs. CONCLUSIONS: In these patients with MFS with aortic dissection, open TAAA repair incurred reasonable operative risk, but improvements are needed to reduce rates of renal failure. Extent II TAAA repair does not appear to increase operative risk in patients with MFS. CI - Copyright (c) 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Coselli, Joseph S AU - Coselli JS AD - Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas. FAU - Green, Susan Y AU - Green SY AD - Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas. FAU - Price, Matt D AU - Price MD AD - Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas. FAU - Hash, Jonathan A AU - Hash JA AD - Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas. FAU - Ouyang, Yafei AU - Ouyang Y AD - Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas. FAU - Volguina, Irina V AU - Volguina IV AD - Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas. FAU - Preventza, Ourania AU - Preventza O AD - Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas. FAU - de la Cruz, Kim I AU - de la Cruz KI AD - Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas. FAU - LeMaire, Scott A AU - LeMaire SA AD - Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas. Electronic address: slemaire@bcm.edu. LA - eng PT - Comparative Study PT - Journal Article DEP - 20160212 PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - IM MH - Adult MH - Aortic Dissection/diagnosis/mortality/*surgery MH - Aortic Aneurysm, Thoracic/etiology/mortality/*surgery MH - Blood Vessel Prosthesis Implantation/methods/*mortality MH - Databases, Factual MH - Female MH - *Hospital Mortality MH - Humans MH - Kaplan-Meier Estimate MH - Male MH - Marfan Syndrome/complications/mortality/*surgery MH - Middle Aged MH - Postoperative Complications/mortality/physiopathology MH - Prognosis MH - Retrospective Studies MH - Risk Assessment MH - Statistics, Nonparametric MH - Survival Analysis MH - Thoracotomy/methods MH - Treatment Outcome EDAT- 2016/02/16 06:00 MHDA- 2017/03/28 06:00 CRDT- 2016/02/16 06:00 PHST- 2014/11/07 00:00 [received] PHST- 2015/11/03 00:00 [revised] PHST- 2015/11/04 00:00 [accepted] PHST- 2016/02/16 06:00 [entrez] PHST- 2016/02/16 06:00 [pubmed] PHST- 2017/03/28 06:00 [medline] AID - S0003-4975(15)01847-0 [pii] AID - 10.1016/j.athoracsur.2015.11.008 [doi] PST - ppublish SO - Ann Thorac Surg. 2016 Jun;101(6):2193-201. doi: 10.1016/j.athoracsur.2015.11.008. Epub 2016 Feb 12.