skip to main content

Combined MV and Aortic Surgery in Marfan — EECC MCQ

Instant feedback + full explanation. One question, done properly.

HardValvular Heart DiseaseCombined MV and Aortic Surgery in MarfanEECC

A 55-year-old man with Marfan syndrome and severe MR due to myxomatous mitral valve prolapse requires surgery. His ascending aorta is 42 mm. What surgical approach is recommended?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Combined aortic root replacement (or valve-sparing root replacement) with mitral valve repair, as the ascending aorta in Marfan will likely require intervention in the future and the lower surgical threshold (≥45 mm) is close

In Marfan syndrome, the surgical threshold for prophylactic aortic root replacement is ≥50 mm (or ≥45 mm with risk factors: family history of dissection, aortic growth >3 mm/year, severe AR, desire for pregnancy). When a patient requires cardiac surgery for another indication (e.g. mitral valve repair), concomitant prophylactic aortic root replacement should be considered at smaller diameters (≥45 mm), as the incremental surgical risk is modest and avoids a future high-risk redo operation. Valve-sparing root replacement (David or Yacoub procedure) is preferred when the aortic valve leaflets are suitable. The 2025 ESC VHD and 2024 Aortic Disease Guidelines support this combined approach.

Reference: ESC/EACTS (2025): VHD Guidelines; ESC (2024): Aortic Disease Guidelines