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The Beneficial Effect of Renin-Angiotensin- Aldosterone System Blockade in Marfan Syndrome Patients after Aortic Root Replacement

 Seung-Jun Lee  ;  Jaewon Oh  ;  Young-Guk Ko  ;  Sak Lee  ;  Byung-Chul Chang  ;  Do Yun Lee  ;  Young-Ran Kwak  ;  Donghoon Choi 
 YONSEI MEDICAL JOURNAL, Vol.57(1) : 81-87, 2016 
Journal Title
Issue Date
Adrenergic beta-Antagonists/pharmacology ; Aged ; Aneurysm, Dissecting/complications ; Aneurysm, Dissecting/mortality ; Aneurysm, Dissecting/surgery ; Angiotensin Receptor Antagonists* ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use* ; Aorta/pathology ; Aorta/surgery* ; Aortic Aneurysm/complications ; Aortic Aneurysm/mortality ; Aortic Aneurysm/surgery ; Aortic Valve ; Female ; Humans ; Male ; Marfan Syndrome/mortality ; Marfan Syndrome/surgery* ; Middle Aged ; Renin-Angiotensin System/drug effects*
ACE inhibitor ; Marfan syndrome ; RAAS blockade ; angiotensin receptor blocker
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 β-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 β-blocker was associated with reduction of aortic dilatation and clinical events.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Oh, Jae Won(오재원) ORCID logo https://orcid.org/0000-0002-4585-1488
Lee, Do Yun(이도연)
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Lee, Seung Jun(이승준) ORCID logo https://orcid.org/0000-0002-9201-4818
Chang, Byung Chul(장병철)
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
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