Results:

A total of 146 patients with Marfan syndrome had aortic valve-sparing operations during the study interval. Re-implantation of the aortic valve was performed in 121, and remodeling of the aortic root was performed in 25 patients. Mean age was 35.7 ± 11.4 years, and two thirds were men. Before surgery, nine patients had acute type A aortic dissection, two had chronic type A dissection, and three had chronic type B aortic dissection. There was one operative death and six late deaths; five deaths were due to complications of dissection. Mortality rate at 15 years was 6.8 ± 2.9%, higher than that expected in a general population matched for age and sex. Reoperation was required in five patients: two for infective endocarditis, and three for aortic insufficiency (AI). After surgery, three patients developed severe AI, four developed moderate AI, and three mild-to-moderate AI; the rate of AI at 15 years was 7.9 ± 3.3%, and was lower after aortic valve re-implantation than after aortic remodeling. New distal aortic dissections occurred during follow-up in nine patients; the rate of aortic dissection at 15 years was 16.5 ± 3.4%.