LAUSR

SEE PAGE 1095 A ortic and cardiovascular complications are an important cause of mortality in patients with Marfan syndrome, and cardiovascular surgery is an important reason why life expectancy for Marfan patients has increased over time (1). The most commonly performed cardiovascular procedure in Marfan patients is replacement of the proximal aortic root and ascending aorta, that is, the Bentall procedure (2). Although the early and long-term results of the Bentall procedure are good, patients must live with the lifetime consequences of a prosthetic aortic valve. Valve-sparing root replacement (VSRR) surgery is an attractive option for patients with aortic root aneurysms. First described by David and Feindel (3), the aortic valve reimplantation (i.e., David) procedure is the most commonly performed VSRR operation. The David operation has become the surgical treatment of choice in many reference centers for patients with Marfan syndrome and other connective tissue disorders (4,5). Such operations prevent future complications of aortic root aneurysms (i.e., dissection, rupture, or sudden death), while avoiding known complications of aortic valve prostheses. However, the David operation is technically more complicated than the Bentall procedure and may be associated with increased rates of recurrent aortic regurgitation (6). Technical challenges associated with the David procedure are a concern, particularly since the median number of aortic root operations performed annually in cardiac surgery centers within the United States is only 2 (7).