What is the current thinking regarding the proper timing of aortic root replacement for Marfan patients?
It has been the general feeling of Marfan surgeons that aortic root replacement should be carried out when the aneurysm diameter reaches 6 cm. Frequently, patients with this aortic diameter will be completely asymptomatic. With the almost-routine use of the coronary button technique at Johns Hopkins, we are now recommending prophylactic surgery when the aortic root reaches 5.5 cm. If there is a history of dissection in the family, then we would recommend surgery when the root diameter reaches 5 cm. Determining the proper time for aortic root replacement in children with Marfan disease can be difficult. Each child has to be individualized; for example, a nine-year-old child with a 4 cm aneurysm would certainly merit operative intervention. Also, the rapidity of aortic root enlargement is a factor in determining when to operate in children.
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