Should aortic arch replacement be performed during initial surgery for aortic root aneurysm in patients with Marfan syndrome?

The authors reviewed their 16 year experience with Marfan syndrome patients (94) requiring surgical intervention, presenting with acute aortic dissection  in 35% of patients (76% Type A and 24% Type B) and aneurysmal disease in 65%.  Total arch replacement was performed initially in 8% of patients for acute aortic dissection. Reoperative total arch replacement  had to be performed in 33% of patients with initial presentation of acute aortic dissection and in 3% of patients without aortic dissection.  Operative and 30-day mortality for secondary total arch replacement was 0.  The authors recommend  limiting surgery to the aortic root, ascending aorta and proximal aortic arch  in Marfan syndrome patients presenting with acute aortic dissection.