The Florida Sleeve Procedure Improves Aortic Valve Function in Marfan’s Syndrome Patients
Seyed Hossein Aalaei Andabili1, Tomas Martin2, Philip Hess3, Charles klodell1, Teng Lee1, Thomas Beaver1.
1Division of Thoracic and Cardiovascular Surgery, Gainesville, FL, USA, 2Division of Thoracic and Cardiovascular Surgery, Orlando, FL, USA, 3Division of Thoracic and Cardiovascular Surgery, Indiana University, Indianapolis, IN, USA.
OBJECTIVE: The Florida Sleeve (FS) procedure was developed as a simplified approach for repair of functional type I aortic insufficiency (AI) secondary to aortic root aneurysm. We evaluated post-operative aortic valve function and long term survival of Marfan’s disease patients who underwent the Florida Sleeve procedure at our center.
METHODS: Marfan’s patients undergoing Florida Sleeve between May 2002 and March 2014 were examined for in hospital and long term outcomes. Echo assessment included Left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), ejection fraction (EF), and degree of AI (none=0, minimal=1, mild=2, moderate=3, severe=4). SSDI was used for long term follow-up.
RESULTS: Thirty four Marfan’s patients, 21 (61.8%) male and 13 (38.2%) female mean age 35.29±13.78 years had Florida Sleeve repair at our center. There was no in-hospital or 30-day death or stroke (table-1). Two patients required reoperation due to bleeding. One and two year survival rates were 98%, and 88% at 5 years (figure-1). Fifteen patients had post-operative follow up echo at one week. AI grade significantly decreased after the procedure, (preoperative mean=2.13±1.06 versus one week post-operative mean=0.84±0.89, p-value=0.020); and mean LVEDD decreased from 55.77±7.51 to 50.07±8.36; and mean LVESD decreased from 38.66±8.27 to 35.64±10.57 (p-value=0.16 and 0.77, respectively). There was no significant change in EF (p-value=0.19). Seven patients with more than 1 year postoperative echo follow-up showed persistent improvement of AI grade and stable ventricular dimensions.
CONCLUSIONS: The Florida sleeve procedure can be performed safely in Marfan’s patients with immediate improvement in aortic valve function. Long-term survival rate is acceptable though further follow up is required.
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