{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T01:44:58Z","timestamp":1789263898310,"version":"build-2803163510"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2014,4]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Data on outcomes after Stanford type A aortic dissection in patients with Marfan syndrome are limited. We investigated the primary surgery and long-term results in patients with Marfan syndrome who suffered aortic dissection.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>Among 1324 consecutive patients with aortic dissection type A, 74 with Marfan syndrome (58% men; median age, 37 years [first and third quartiles, 29 and 48 years]) underwent surgical repair (85% acute dissections; 68% DeBakey I; 55% composite valved graft, 30% supracoronary ascending replacement, 15% valve-sparing aortic root replacement; 12% total arch replacement; 3% in-hospital mortality) at 2 tertiary centers in the United States and Europe over the past 25 years. The rate of aortic reintervention with resternotomy was 24% (18 of 74) and of descending aorta (thoracic+abdominal) intervention was 30% (22 of 74) at a median follow-up of 8.4 years (first and third quartiles, 2.2 and 12.7 years). Freedom from need for aortic root reoperation in patients who underwent primarily a composite valved graft or valve-sparing aortic root replacement procedure was 95\u00b13%, 88\u00b15%, and 79\u00b15% and in patients who underwent supracoronary ascending replacement was 83\u00b19%, 60\u00b113%, 20\u00b116% at 5, 10, and 20 years. Secondary aortic arch surgery was necessary only in patients with initial hemi-arch replacement.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Emergency surgery for type A dissection in patients with Marfan syndrome is associated with low in-hospital mortality. Failure to extend the primary surgery to aortic root or arch repair leads to a highly complex clinical course. Aortic root replacement or repair is highly recommended because supracoronary ascending replacement is associated with a high need (&gt;40%) for root reintervention.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.113.005865","type":"journal-article","created":{"date-parts":[[2014,3,5]],"date-time":"2014-03-05T05:06:58Z","timestamp":1393996018000},"page":"1381-1386","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":84,"title":["Type A Aortic Dissection in Marfan Syndrome"],"prefix":"10.1161","volume":"129","author":[{"given":"Bartosz","family":"Rylski","sequence":"first","affiliation":[{"name":"From the Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania in Philadelphia (BR., J.E.B., E.B., N.D.D., R.K.M., W.Y.S., P.V.); and Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany (B.R., F.B., M.S., F.A.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph E.","family":"Bavaria","sequence":"additional","affiliation":[{"name":"From the Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania in Philadelphia (BR., J.E.B., E.B., N.D.D., R.K.M., W.Y.S., P.V.); and Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany (B.R., F.B., M.S., F.A.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedhelm","family":"Beyersdorf","sequence":"additional","affiliation":[{"name":"From the Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania in Philadelphia (BR., J.E.B., E.B., N.D.D., R.K.M., W.Y.S., P.V.); and Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany (B.R., F.B., M.S., F.A.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Branchetti","sequence":"additional","affiliation":[{"name":"From the Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania in Philadelphia (BR., J.E.B., E.B., N.D.D., R.K.M., W.Y.S., P.V.); and Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany (B.R., F.B., M.S., F.A.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nimesh D.","family":"Desai","sequence":"additional","affiliation":[{"name":"From the Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania in Philadelphia (BR., J.E.B., E.B., N.D.D., R.K.M., W.Y.S., P.V.); and Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany (B.R., F.B., M.S., F.A.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita K.","family":"Milewski","sequence":"additional","affiliation":[{"name":"From the Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania in Philadelphia (BR., J.E.B., E.B., N.D.D., R.K.M., W.Y.S., P.V.); and Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany (B.R., F.B., M.S., F.A.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson Y.","family":"Szeto","sequence":"additional","affiliation":[{"name":"From the Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania in Philadelphia (BR., J.E.B., E.B., N.D.D., R.K.M., W.Y.S., P.V.); and Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany (B.R., F.B., M.S., F.A.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashanth","family":"Vallabhajosyula","sequence":"additional","affiliation":[{"name":"From the Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania in Philadelphia (BR., J.E.B., E.B., N.D.D., R.K.M., W.Y.S., P.V.); and Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany (B.R., F.B., M.S., F.A.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Siepe","sequence":"additional","affiliation":[{"name":"From the Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania in Philadelphia (BR., J.E.B., E.B., N.D.D., R.K.M., W.Y.S., P.V.); and Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany (B.R., F.B., M.S., F.A.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian A.","family":"Kari","sequence":"additional","affiliation":[{"name":"From the Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania in Philadelphia (BR., J.E.B., E.B., N.D.D., R.K.M., W.Y.S., P.V.); and Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany (B.R., F.B., M.S., F.A.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3182902cca"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.08.054"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3181d4739e"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.001457"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezs674"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2009.01.073"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199904293401702"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.2009.072785"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-200109000-00007"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2004.04.049"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.07.013"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezs342"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.108.844480"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2006.10.085"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000155243.70456.f4"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.11.075"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2012.08.043"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000032850.20885.9b"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2012.04.094"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezs705"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2001.115238"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.113.005865","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T06:40:18Z","timestamp":1715582418000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.005865"}},"subtitle":["Extent of Initial Surgery Determines Long-Term Outcome"],"short-title":[],"issued":{"date-parts":[[2014,4]]},"references-count":21,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2014,4]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.113.005865"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.113.005865","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,4]]},"assertion":[{"value":"2013-08-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-01-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-03-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}