Total and subtotal aortic replacement for extensive aortic dissection in patients with or without Marfan’s syndrome

Objectives: Extensive aortic dissection with multiple entries often found in Marfan’s syndrome patients ultimately requires replacement of the whole aorta. We present a surgical strategy and results for total and subtotal arotic replacement.Methods: Subjects were 18 patients, including 14 Marfan’s patients undergoing total (n=13) or subtotal (excluding aortic arch) aortic replacement (n=5), for DeBakey type I aortic dissection (n=13) and DeBakey type IIIb aortic dissection with annuloaortic ectasia (n=5) between February 1991 and April 2001. Mean age was 39.9±0.8 years—34.9±6.6 years in Marfan’s patients vs. 57.7±4.7 years in non-Marfan patients. All operations were staged, with the mean number required per patient 3.1±0.8.Results: Early mortality was 0% and late mortality 11% (2 of 18). Paraplegia or paraparesis occurring in 11%. Except for these patients, all current survivors enjoy good quality of life.Conclusions: Total and subtotal aortic replacement for extensive aortic dissection may decrease mortality due to rupture or associated disease.