{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T11:30:05Z","timestamp":1791545405901,"version":"4.3.4"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2013,4,16]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>The aim of the current study was to investigate incidence and causes of surgical interventions in primarily nontreated aortic segments after previous aortic repair in patients with Marfan syndrome.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Retrospective analysis of 86 consecutive Marfan syndrome patients fulfilling Ghent criteria that underwent 136 aortic surgeries and were followed at this institution in the past 15 years. Mean follow-up was 8.8\u00b16.8 y. Thirty-day, 6-month, 1-year, and overall mortality was 3.5%, 5.8%, 7.0%, and 12.8%, respectively. Ninety-two percent of patients initially presented with aortic root, ascending aortic or arch lesions, whereas 8% presented with descending aortic or thoraco-abdominal lesions. Primary presentation was acute aortic dissection (AAD) in 36% (77% type A, 23% type B) and aneurismal disease in 64%. Secondary complete arch replacement had to be performed in only 6% of patients without AAD, but in 36% with AAD (\n              <jats:italic>P<\/jats:italic>\n              =0.0005). In patients without AAD, 11% required surgery on primarily nontreated aortic segments (5 of 6 patients experienced type B dissection during follow-up), whereas in patients after AAD, 48% underwent surgery of initially nontreated aortic segments (42% of patients with type A and 86% of those with type B dissection;\n              <jats:italic>P<\/jats:italic>\n              =0.0002).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>The need for surgery in primarily nontreated aortic segments is precipitated by an initial presentation with AAD. Early elective surgery is associated with low mortality and reintervention rates. Type B dissection in patients with Marfan syndrome is associated with a high need for extensive aortic repair, even if the dissection is being considered uncomplicated by conventional criteria.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.113.001457","type":"journal-article","created":{"date-parts":[[2013,3,15]],"date-time":"2013-03-15T15:21:22Z","timestamp":1363360882000},"page":"1569-1575","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":84,"title":["Acute Aortic Dissection Determines the Fate of Initially Untreated Aortic Segments in Marfan Syndrome"],"prefix":"10.1161","volume":"127","author":[{"given":"Florian S.","family":"Schoenhoff","sequence":"first","affiliation":[{"name":"From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children\u2019s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvan","family":"Jungi","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children\u2019s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Czerny","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children\u2019s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Roost","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children\u2019s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Reineke","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children\u2019s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabor","family":"Matyas","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children\u2019s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beat","family":"Steinmann","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children\u2019s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juerg","family":"Schmidli","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children\u2019s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Kadner","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children\u2019s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Carrel","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (F.S.S., S.J., M.C., E.R., D.R., J.S., A.K., T.C.); the Division of Metabolism and Molecular Pediatrics, University Children\u2019s Hospital Zurich, Zurich, Switzerland (G.M., B.S.); the Institute of Medical Genetics, Division of Medical Molecular Genetics and Gene Diagnostics, University of Zurich, Zurich, Switzerland (G.M.); and the Center for Cardiovascular Genetics and Gene Diagnostics, Zurich, Switzerland (G..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67789-6"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/352337a0"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199904293401702"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3181d4739e"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000155243.70456.f4"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2009.01.073"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2005.081638"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.91.3.728"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2006.10.056"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.2217\/fca.11.37"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2002.118497"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(01)03336-7"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2006.03.073"},{"key":"e_1_3_3_15_2","first-page":"62","article-title":"Valve-preserving aortic root reconstruction: a comparison of techniques.","volume":"12","author":"Burkhart HM","year":"2003","unstructured":"Burkhart HM, Zehr KJ, Schaff HV, Daly RC, Dearani JA, Orszulak TA. 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