Muhammad Aftab1, Frank S Cikach2, Yuanjia Zhu2, Jay J Idrees2, Christina M Rigelsky3, Vidyasagar Kalahasti4, Eric E Roselli2, Lars G Svensson5. 1. Aorta Center, Marfan Syndrome and Connective Tissue Disorder Clinic, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado, Denver, Colo. 2. Aorta Center, Marfan Syndrome and Connective Tissue Disorder Clinic, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 3. Aorta Center, Marfan Syndrome and Connective Tissue Disorder Clinic, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio. 4. Aorta Center, Marfan Syndrome and Connective Tissue Disorder Clinic, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 5. Aorta Center, Marfan Syndrome and Connective Tissue Disorder Clinic, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: svenssl@ccf.org.
Abstract
OBJECTIVES: Loeys-Dietz syndrome (LDS) is an aggressive connective tissue disorder associated with increased risk of aortic dissection and aneurysm rupture at an early age and smaller aortic diameters. We report our experience with LDS to better understand its natural history and treatment outcomes and help establish treatment guidelines. METHODS: We retrospectively reviewed all patients with LDS who underwent medical or surgical treatment at Cleveland Clinic before April 27, 2017. Primary endpoints were postoperative in-hospital morbidity and mortality. Secondary endpoints were aorta-related reoperations and short- and long-term mortality. RESULTS: We identified 53 patients with LDS. Of these, 33 (62%) underwent aortic surgery. Mean age was 39 ± 14 years, and mean maximum aortic diameter was 4.3 cm. There were 2 (6%) deaths after urgent or emergency surgery. Twenty-two patients (67%) required no aortic reoperation; 20 of these had prophylactic surgery. Multiple aortic operations were performed on 11 (33%) patients, 9 of whom experienced aortic dissections. Six patients (18%) required total aortic replacement. Among 19 patients with modified root reimplantation, no aorta- or valve-related complications occurred. Overall, 33 patients underwent 58 aortic and 81 cardiovascular operations, with 1 late death. Kaplan-Meier survival of the aortic-surgery cohort was 89% at 10 years (median follow-up 5.2 years). There were no late deaths in the non-aortic surgery group (20/53; 38%). CONCLUSIONS: Prophylactic aortic surgical outcomes in LDS are excellent. Surgical reintervention remains high, particularly after aortic dissections. Close surveillance of medically managed and postoperative patients and early prophylactic surgery are crucial to avoid aortic catastrophe and achieve a good long-term prognosis.
OBJECTIVES:Loeys-Dietz syndrome (LDS) is an aggressive connective tissue disorder associated with increased risk of aortic dissection and aneurysm rupture at an early age and smaller aortic diameters. We report our experience with LDS to better understand its natural history and treatment outcomes and help establish treatment guidelines. METHODS: We retrospectively reviewed all patients with LDS who underwent medical or surgical treatment at Cleveland Clinic before April 27, 2017. Primary endpoints were postoperative in-hospital morbidity and mortality. Secondary endpoints were aorta-related reoperations and short- and long-term mortality. RESULTS: We identified 53 patients with LDS. Of these, 33 (62%) underwent aortic surgery. Mean age was 39 ± 14 years, and mean maximum aortic diameter was 4.3 cm. There were 2 (6%) deaths after urgent or emergency surgery. Twenty-two patients (67%) required no aortic reoperation; 20 of these had prophylactic surgery. Multiple aortic operations were performed on 11 (33%) patients, 9 of whom experienced aortic dissections. Six patients (18%) required total aortic replacement. Among 19 patients with modified root reimplantation, no aorta- or valve-related complications occurred. Overall, 33 patients underwent 58 aortic and 81 cardiovascular operations, with 1 late death. Kaplan-Meier survival of the aortic-surgery cohort was 89% at 10 years (median follow-up 5.2 years). There were no late deaths in the non-aortic surgery group (20/53; 38%). CONCLUSIONS: Prophylactic aortic surgical outcomes in LDS are excellent. Surgical reintervention remains high, particularly after aortic dissections. Close surveillance of medically managed and postoperative patients and early prophylactic surgery are crucial to avoid aortic catastrophe and achieve a good long-term prognosis.
Authors: Kristina Mühlstädt; Julie De Backer; Yskert von Kodolitsch; Kerstin Kutsche; Laura Muiño Mosquera; Jens Brickwedel; Evaldas Girdauskas; Thomas S Mir; Adrian Mahlmann; Nikolaos Tsilimparis; Axel Staebler; Lauritz Schoof; Heide Seidel; Jürgen Berger; Alexander M Bernhardt; Stefan Blankenberg; Tilo Kölbel; Christian Detter; Katalin Szöcs; Harald Kaemmerer Journal: J Clin Med Date: 2019-11-29 Impact factor: 4.241