| Valve and Conduit Replacements |
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Marfan's Syndrome - Aortic Root Replacement
In cases of Marfan's Syndrome where the aortic root becomes enlarged to the point that the patient is at risk of dissection, the root may need to be surgically replaced. Surgery is usually indicated if the aortic root diameter exceeds 45 mm when the aortic valve can be spared, or when it exceeds 55 mm in cases where the aortic valve cannot be spared.
There are a number of approaches to surgical repair, all of which involve the replacement of a portion or portions of the ascending aorta with a conduit.
1) The entire aortic root and aortic valve are replaced by a valved conduit. The valve may be mechanical, homograft, or bioprosthetic; the aortic root may be a homograft or made of a synthetic material. The coronary arteries are reimplanted into the conduit.
2) Reimplantation of the aortic valve, in which the patient's aortic valve is reimplanted within a round Dacron® graft and the coronary arteries are attached to a homograft or synthetic ascending aortic conduit.
3) Remodelling of the aortic root, in which the fibrous portion of the left ventricular outflow tract is surrounded by a Dacron® strip, often involving the reduction in size of the aortic annulus, and the coronary arteries are attached to a homograft or synthetic ascending aortic conduit.
Most surgically implanted valves and conduits will last 10-20 years before they wear out, become obstructed, or lose efficiency. When their function becomes impaired for any of these reasons, replacement becomes necessary.
Even after surgical replacement of the aortic root, the enlargement or rupture of the aorta remains a life-long risk. There is also the chance that aortic or mitral regurgitation may develop. Therefore, all Marfans' patients should be monitored regularly. |
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