In a large multicentre cohort of adults with Marfan syndrome, cardiac surgery was common and redo sternotomy occurred frequently among operated patients, with hypertension, emergent initial operation, and postoperative complications independently associated with increased odds of redo sternotomy.
The majority of adults with Marfan syndrome in this cohort underwent at least one cardiac operation.
Redo sternotomy was required in nearly one-quarter of the total cohort and nearly half of operated patients.
The most common cardiac procedures performed were aortic root interventions, followed by aortic valve, mitral valve, and tricuspid valve interventions.
Valvular abnormalities were highly prevalent in this Marfan syndrome cohort.
Major postoperative complications occurred in 15.3% of patients following cardiac surgery.
Hypertension was independently associated with increased odds of redo sternotomy on multivariate analysis.
Emergent initial cardiac operation was independently associated with substantially increased odds of redo sternotomy.
Postoperative complications following the initial cardiac operation were independently associated with increased odds of redo sternotomy.
Aortic repair extending beyond the aortic root was associated with significantly lower odds of redo sternotomy.
This research suggests that adults with Marfan syndrome—a genetic condition that affects connective tissue and frequently leads to problems with the aorta and heart valves—face a very high likelihood of needing heart surgery during their lifetime. In a study of 783 adults seen at three Mayo Clinic locations, more than half (58%) underwent at least one cardiac operation, and among those who had surgery, 41% eventually required a second or subsequent open-heart surgery through the same chest incision (called a redo sternotomy). The most common procedures were on the aortic root and aortic valve, though many patients also needed mitral or tricuspid valve surgery. Valve abnormalities such as mitral regurgitation and tricuspid regurgitation were extremely common in this population. The study identified several factors that increased the likelihood of needing repeat cardiac surgery. Having high blood pressure (hypertension), undergoing an emergency initial heart surgery, and experiencing major complications after the first surgery were all independently associated with higher odds of requiring a redo sternotomy. In contrast, patients who had a more extensive initial aortic repair—one that extended beyond just the aortic root—were significantly less likely to need repeat surgery. Major postoperative complications occurred in about 15% of surgical patients, underscoring the complexity of cardiac surgery in this population. This research suggests that early, proactive management of Marfan syndrome—including blood pressure control and timely (rather than emergent) surgical intervention—may help reduce the need for repeat open-heart surgeries. The finding that more extensive initial aortic repair lowers the risk of redo surgery could have implications for surgical planning. These results provide an important contemporary picture of the long-term cardiac surgical burden faced by adults with Marfan syndrome cared for at specialized referral centers.
Abdul Nabi H, Dreher L, Kanaan C, Mousa H, Kandil O, Crossley A, et al.. (2026). Cardiac surgical outcomes and predictors of redo sternotomy in patients with Marfan syndrome: a retrospective multicentre cohort study.. Open heart. https://doi.org/10.1136/openhrt-2026-004138