The Beneficial Effect of Renin-Angiotensin-Aldosterone System Blockade in Marfan Syndrome Patients after Aortic Root Replacement.
- Author:
Seung Jun LEE
1
;
Jaewon OH
;
Young Guk KO
;
Sak LEE
;
Byung Chul CHANG
;
Do Yun LEE
;
Young Ran KWAK
;
Donghoon CHOI
Author Information
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords: Marfan syndrome; angiotensin receptor blocker; ACE inhibitor; RAAS blockade
- MeSH: Adrenergic beta-Antagonists/pharmacology; Aged; Aneurysm, Dissecting/complications/mortality/surgery; *Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors/*therapeutic use; Aorta/pathology/*surgery; Aortic Aneurysm/complications/mortality/surgery; Aortic Valve; Female; Humans; Male; Marfan Syndrome/mortality/*surgery; Middle Aged; Renin-Angiotensin System/*drug effects
- From:Yonsei Medical Journal 2016;57(1):81-87
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: In this study, we evaluated the long term beneficial effect of Renin-Angiotensin-Aldosterone System (RAAS) blockade therapy in treatment of Marfan aortopathy. MATERIALS AND METHODS: We reviewed Marfan syndrome (MFS) patients who underwent aortic root replacement (ARR) between January 1996 and January 2011. All patients were prescribed beta-blockers indefinitely. We compared major aortic events including mortality, aortic dissection, and reoperation in patients without RAAS blockade (group 1, n=27) to those with (group 2, n=63). The aortic growth rate was calculated by dividing the diameter change on CT scans taken immediately post-operatively and the latest scan available. RESULTS: There were no differences in clinical parameters except for age which was higher in patients with RAAS blockade. In group 1, 2 (7%) deaths, 5 (19%) aortic dissections, and 7 (26%) reoperations occurred. In group 2, 3 (5%) deaths, 2 (3%) aortic dissections, and 3 (5%) reoperations occurred. A Kaplan-Meier plot demonstrated improved survival free from major aortic events in group 2. On multivariate Cox, RAAS blockade was an independent negative predictor of major aortic events (hazard ratio 0.38, 95% confidence interval 0.30-0.43, p=0.002). Mean diameter change in descending thoracic and supra-renal abdominal aorta was significantly higher in patients without RAAS blockade (p<0.05). CONCLUSION: In MFS patients who underwent ARR, the addition of RAAS blockade to beta-blocker was associated with reduction of aortic dilatation and clinical events.
