Composite aortic valve replacement and graft replacement of the ascending aorta plus coronary ostial reimplantation: how I do it.

Aortic root replacement in the patient with Marfan syndrome is indicated in the presence of aortic root dilatation more than 6 cm, ascending aortic dissection, or 3 to 4+ aortic valve insufficiency. The objective of operation is to prevent catastrophic aortic rupture or dissection and to treat or prevent aortic insufficiency with consequent left ventricular dysfunction. In over 170 patients undergoing aortic root replacement, operative mortality has been 1%. At mean follow-up of 5 years, the survival rate was 75%. The most frequent serious late postoperative complication has been graft endocarditis (4%). The technique described above carries a low operative risk and late complication rate. We believe it is an important surgical arm in the treatment of cardiovascular complications of the Marfan syndrome.