Introduction and objectives:

Marfan Syndrome constitutes the most common multisystemic hereditary disorder of connective tissue, associated with a high mortality rate due to aortic dissection and rupture. Patients with this syndrome face a limited life expectancy without prophylactic surgical intervention. While the traditional approach to ascending aortic aneurysm involves replacing the root with a composite graft containing a mechanical valve, valvular preservation approaches are currently preferred. This publication aims to analyze the ascending aorta replacement technique with valve reimplantation proposed by Tirone David in two patients with Marfan Syndrome and ascending aortic aneurysm.

Methods:

A prospective 20-month follow-up was conducted, clinically and echocardiographically evaluating two male patients under 30 years of age with MS who underwent the David technique. The average aortic diameter in the Valsalva sinuses was 67mm, and in both patients, the aortic valve was reimplanted in a Dacron tube with Valsalva sinuses.

Results:

Mean CPB and aortic cross-clamp times were 229 min and 190 min respectively. Survival at 20 months was 100%. In none of the patients was there a need for reintervention, nor was there endocarditis, significant residual aortic insufficiency or thromboembolic events. At the last follow-up, both patients were in functional class I of the New York Heart Association.

Conclusions:

The David technique proves to be an excellent option for these patients, effectively reducing complications associated with the valve and improving life expectancy. It provides greater stabilization of all components of the aortic root, including the valvular annulus, and is therefore currently considered the technique of choice.