David-operation vs. Bentall-procedure in patients with Marfans syndrome

Backround: Bentall-operation is still the standard for prophylactic aortic-root replacement in patients with Marfan-syndrome (MFS). Although valve-sparing techniques have shown favourable durability in mid-term and long-term studies, its use is still being debated in patients with MFS.

Methods: Between 1995 and 2009 we used David-technique in 48 Patients (Group 1) and Bentall-technique in 72 Patients with MFS (Group 2). David-procedures were done for aortic-root aneurysm (n=41) or aortic dissection type A (n=7). Mean age in Gr.1 was 35.3 years, 29 (67%) were male. Additional procedures were CABG in 2 patients, mitral valve surgery in 6 patients, repair of an ASD in 2 patients, tricuspid valve reconstruction in 1 patient. Bentall-procedures were done for aortic-root aneurysm in 39 Patients or aortic dissection type A in 34 Patients. Mean age in Gr.2 was 38.2 years, 42 (58%) were male. Additional procedures were arch replacement in 2 patients, CABG in 8 patients, mitral valve surgery in 13 patients.

Results: Thirty day survival in both groups was 100%. 1.4% (1/72) of Gr.2 patients required rethoracotomy for postoperative bleeding versus 4.1% of Gr.1 (2/48). Within the 8-year-follow-up 6.9% (5/72) died in Gr.2, 4.1% (2/48) in Gr.1. Re-operation of the reconstructed valve was required in 2 patients. 4 patients in Gr.2 required re-operation because of endocarditis.

Conclusion: David- and Bentall-technique showed similar results in Marfan-patients. The David-procedure was associated with a low rate of reoperations and potentially eliminate the risk of endocarditis. Lower late survival among Bentall-patients probably reflects the preferential use of the Bentall-procedure for higher risk patients.