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Titolo:
Replacement of the aortic root in patients with Marfan's syndrome
Autore:
Gott, VL; Greene, PS; Alejo, DE; Cameron, DE; Naftel, DC; Miller, DC; Gillinov, AM; Laschinger, JC; Pyeritz, RE;
Indirizzi:
Johns Hopkins Hosp, Div Cardiac Surg, Baltimore, MD 21287 USA Johns Hopkins Hosp Baltimore MD USA 21287 c Surg, Baltimore, MD 21287 USA Univ Alabama, Dept Surg, Birmingham, AL 35294 USA Univ Alabama BirminghamAL USA 35294 Dept Surg, Birmingham, AL 35294 USA Stanford Univ, Med Ctr, Dept Cardiothorac Surg, Stanford, CA 94305 USA Stanford Univ Stanford CA USA 94305 iothorac Surg, Stanford, CA 94305 USA St Joseph Hosp, Div Cardiac Surg, Baltimore, MD USA St Joseph Hosp Baltimore MD USA osp, Div Cardiac Surg, Baltimore, MD USA Allegheny Univ Hlth Sci, Dept Human Genet, Pittsburgh, PA USA Allegheny Univ Hlth Sci Pittsburgh PA USA uman Genet, Pittsburgh, PA USA
Titolo Testata:
NEW ENGLAND JOURNAL OF MEDICINE
fascicolo: 17, volume: 340, anno: 1999,
pagine: 1307 - 1313
SICI:
0028-4793(19990429)340:17<1307:ROTARI>2.0.ZU;2-M
Fonte:
ISI
Lingua:
ENG
Soggetto:
ASCENDING AORTA; ANEURYSMS; OPERATION; GENE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
21
Recensione:
Indirizzi per estratti:
Indirizzo: Gott, VL Johns Hopkins Hosp, Div Cardiac Surg, 618 Blalock Bldg, Baltimore, MD 21287 Johns Hopkins Hosp 618 Blalock Bldg Baltimore MD USA 21287 21287
Citazione:
V.L. Gott et al., "Replacement of the aortic root in patients with Marfan's syndrome", N ENG J MED, 340(17), 1999, pp. 1307-1313

Abstract

Background Replacement of the aortic root with a prosthetic graft and valve in patients with Marfan's syndrome may prevent premature death from rupture of an aneurysm or aortic dissection. We reviewed the results of this surgical procedure at 10 experienced surgical centers. Methods A total of 675 patients with Marfan's syndrome underwent replacement of the aortic root. Survival and morbidity-free survival curves were calculated, and risk factors were determined from a multivariable regression analysis. Results The 30-day mortality rate was 1.5 percent among the 455 patients who underwent elective repair, 2.6 percent among the 117 patients who underwent urgent repair (within 7 days after a surgical consultation), and 11.7 percent among the 103 patients who underwent emergency repair (within 24 hours after a surgical consultation). Of the 675 patients, 202 (30 percent) had aortic dissection involving the ascending aorta. Forty-six percent of the158 adult patients with aortic dissection and a documented aortic diameterhad an aneurysm with a diameter of 6.5 cm or less. There were 114 late deaths (more than 30 days after surgery); dissection or rupture of the residual aorta (22 patients) and arrhythmia (21 patients) were the principal causes of late death. The risk of death was greatest within the first 60 days after surgery, then rapidly decreased to a constant level by the end of the first year. Conclusions Elective aortic-root replacement has a low operative mortality. In contrast, emergency repair, usually for acute aortic dissection, is associated with a much higher early mortality. Because nearly half the adult patients with aortic dissection had an aortic-root diameter of 6.5 cm or less at the time of operation, it may be prudent to undertake prophylactic repair of aortic aneurysms in patients with Marfan's syndrome when the diameter of the aorta is well below that size. (N Engl J Med 1999;340:1307-13. ) (C)1999, Massachusetts Medical Society.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 25/11/20 alle ore 07:09:49