The evolution of surgical and medical treatment of aortic root aneurysm

Abstract

Since first report of aortic root replacement in 1968, the surgical risk and long term outcome of patients with aortic root aneurysm have been continuously improving. In the last 30 years, the surgical approach is also evolving towards more valve conservation with prophylactical intervention at an earlier clinical stage. Translational research has also led to emerging surgical innovation and new drug therapy. Their efficacies are currently under vigorous clinical trials and evaluations.

Keywords

aortic root aneurysm / aortic root replacement / valve sparing root replacement / personalised external aortic root support

References

[1] Olsson C, Thelin S, Ståhle E, Ekbom A, Granath F. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation2006; 114(24): 2611–2618

[2] Howard DP, Banerjee A, Fairhead JF, Perkins J, Silver LE, Rothwell PM; Oxford Vascular Study. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation2013; 127(20): 2031–2037

[3] Jeremy RW, Huang H, Hwa J, McCarron H, Hughes CF, Richards JG. Relation between age, arterial distensibility, and aortic dilatation in the Marfan syndrome. Am J Cardiol1994; 74(4): 369–373

[4] Murdoch JL, Walker BA, Halpern BL, Kuzma JW, McKusick VA. Life expectancy and causes of death in the Marfan syndrome. N Engl J Med1972; 286(15): 804–808

[5] Cooley DA, Bloodwell RD, Beall AC Jr, Hallman GL, De Bakey ME. Surgical management of aneurysms of the ascending aorta. Including those associated with aortic valvular incompetence. Surg Clin North Am1966; 46(4): 1033–1044

[6] Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax1968; 23(4): 338–339

[7] Isselbacher EM. Thoracic and abdominal aortic aneurysms. Circulation2005; 111(6): 816–828

[8] Pepper J, Golesworthy T, Utley M, Chan J, Ganeshalingam S, Lamperth M, Mohiaddin R, Treasure T. Manufacturing and placing a bespoke support for the Marfan aortic root: description of the method and technical results and status at one year for the first ten patients. Interact Cardiovasc Thorac Surg2010; 10(3): 360–365

[9] Murgatroyd F, Child A, Poloniecki J, Treasure T, Pumphrey C. Does routine echocardiographic measurement of the aortic root diameter predict the risk of aortic dissection in the Marfan syndrome. European Heart Journal1991; 12(abstract supplement): 410

[10] Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, Flachskampf F, Hall R, Iung B, Kasprzak J, Nataf P, Tornos P, Torracca L, Wenink A;Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology; ESC Committee for Practice Guidelines. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J2007; 28(2): 230–268

[11] Benedetto U, Melina G, Takkenberg JJ, Roscitano A, Angeloni E, Sinatra R. Surgical management of aortic root disease in Marfan syndrome: a systematic review and meta-analysis. Heart2011; 97(12): 955–958

[12] Gott VL, Greene PS, Alejo DE, Cameron DE, Naftel DC, Miller DC, Gillinov AM, Laschinger JC, Pyeritz RE. Replacement of the aortic root in patients with Marfan’s syndrome. N Engl J Med1999; 340(17): 1307–1313

[13] Gott VL, Cameron DE, Alejo DE, Greene PS, Shake JG, Caparrelli DJ, Dietz HC. Aortic root replacement in 271 Marfan patients: a 24-year experience. Ann Thorac Surg2002; 73(2): 438–443

[14] Kim SY, Martin N, Hsia EC, Pyeritz RE, Albert DA. Management of aortic disease in Marfan syndrome: a decision analysis. Arch Intern Med2005; 165(7): 749–755

[15] Yacoub MH, Gehle P, Chandrasekaran V, Birks EJ, Child A, Radley-Smith R. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg1998; 115(5): 1080–1090

[16] David TE, Armstrong S, Ivanov J, Feindel CM, Omran A, Webb G. Results of aortic valve-sparing operations. J Thorac Cardiovasc Surg2001; 122(1): 39–46

[17] Westaby S, Saito S, Anastasiadis K, Moorjani N, Jin XY. Aortic root remodeling in atheromatous aneurysms: the role of selected sinus repair. Eur J Cardiothorac Surg2002; 21(3): 459–464

[18] Komiya T, Tamura N, Sakaguchi G, Kobayashi T. Modified partial aortic root remodeling in acute type A aortic dissection. Interact Cardiovasc Thorac Surg2009; 8(3): 306–309

[19] Charitos EI, Stierle U, Sievers HH, Misfeld M. Valve-sparing aortic root remodeling with partial preservation of the intact native aortic sinuses. Eur J Cardiothorac Surg2009; 36(3): 589–591

[20] Treasure T, Crowe S, Chan KM, Ranasinghe A, Attia R, Lees B, Utley M, Golesworthy T, Pepper J. A method for early evaluation of a recently introduced technology by deriving a comparative group from existing clinical data: a case study in external support of the Marfan aortic root. BMJ Open2012; 2(2): e000725

[21] Treasure T, Takkenberg JJ, Golesworthy T, Rega F, Petrou M, Rosendahl U, Mohiaddin R, Rubens M, Thornton W, Lees B, Pepper J. Personalised external aortic root support (PEARS) in Marfan syndrome: analysis of 1-9 year outcomes by intention-to-treat in a cohort of the first 30 consecutive patients to receive a novel tissue and valve-conserving procedure, compared with the published results of aortic root replacement. Heart2014; 100(12): 969–975

[22] Shores J, Berger KR, Murphy EA, Pyeritz RE. Progression of aortic dilatation and the benefit of long-term beta-adrenergic blockade in Marfan’s syndrome. N Engl J Med1994; 330(19): 1335–1341

[23] Silverman DI, Burton KJ, Gray J, Bosner MS, Kouchoukos NT, Roman MJ, Boxer M, Devereux RB, Tsipouras P. Life expectancy in the Marfan syndrome. Am J Cardiol1995; 75(2): 157–160

[24] Collod-Béroud G, Le Bourdelles S, Ades L, Ala-Kokko L, Booms P, Boxer M, Child A, Comeglio P, De Paepe A, Hyland JC, Holman K, Kaitila I, Loeys B, Matyas G, Nuytinck L, Peltonen L, Rantamaki T, Robinson P, Steinmann B, Junien C, Béroud C, Boileau C. Update of the UMD-FBN1 mutation database and creation of an FBN1 polymorphism database. Hum Mutat2003; 22(3): 199–208

[25] Neptune ER, Frischmeyer PA, Arking DE, Myers L, Bunton TE, Gayraud B, Ramirez F, Sakai LY, Dietz HC. Dysregulation of TGF-beta activation contributes to pathogenesis in Marfan syndrome. Nat Genet2003; 33(3): 407–411

[26] Habashi JP, Judge DP, Holm TM, Cohn RD, Loeys BL, Cooper TK, Myers L, Klein EC, Liu G, Calvi C, Podowski M, Neptune ER, Halushka MK, Bedja D, Gabrielson K, Rifkin DB, Carta L, Ramirez F, Huso DL, Dietz HC. Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of Marfan syndrome. Science2006; 312(5770): 117–121

[27] Brooke BS, Habashi JP, Judge DP, Patel N, Loeys B, Dietz HC 3rd. Angiotensin II blockade and aortic-root dilation in Marfan’s syndrome. N Engl J Med2008; 358(26): 2787–2795

[28] Groenink M, den Hartog AW, Franken R, Radonic T, de Waard V, Timmermans J, Scholte AJ, van den Berg MP, Spijkerboer AM, Marquering HA, Zwinderman AH, Mulder BJ. Losartan reduces aortic dilatation rate in adults with Marfan syndrome: a randomized controlled trial. Eur Heart J2013; 34(45): 3491–3500

[29] Mullen MJ, Flather MD, Jin XY, Newman WG, Erdem G, Gaze D, Valencia O, Banya W, Foley CE, Child A. A prospective, randomized, placebo-controlled, double-blind, multicenter study of the effects of irbesartan on aortic dilatation in Marfan syndrome (AIMS trial): study protocol. Trials2013; 14(1): 408

[30] Lacro RV, Dietz HC, Wruck LM, Bradley TJ, Colan SD, Devereux RB, Klein GL, Li JS, Minich LL, Paridon SM, Pearson GD, Printz BF, Pyeritz RE, Radojewski E, Roman MJ, Saul JP, Stylianou MP, Mahony L; Pediatric Heart Network Investigators<?Pub Caret?>. Rationale and design of a randomized clinical trial of beta-blocker therapy (atenolol) versus angiotensin II receptor blocker therapy (losartan) in individuals with Marfan syndrome. Am Heart J2007; 154(4): 624–631

[31] Lacro RV, Guey LT, Dietz HC, Pearson GD, Yetman AT, Gelb BD, Loeys BL, Benson DW, Bradley TJ, De Backer J, Forbus GA, Klein GL, Lai WW, Levine JC, Lewin MB, Markham LW, Paridon SM, Pierpont ME, Radojewski E, Selamet Tierney ES, Sharkey AM, Wechsler SB, Mahony L; Pediatric Heart Network Investigators.Characteristics of children and young adults with Marfan syndrome and aortic root dilation in a randomized trial comparing atenolol and losartan therapy. Am Heart J2013; 165(5): 828–835, e3

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