Evolution and Current Applications of the Cabrol Procedure and Its Modifications

Kourliouros, Antonios; Soni, Monika; Rasoli, Sonia; Grapsa, Julia; Nihoyannopoulos, Petros; O’Regan, Declan P; Athanasiou, Thanos

doi:10.1016/j.athoracsur.2011.01.061

Cited by 49 publications

(49 citation statements)

References 35 publications

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“…The Cabrol procedure is one such surgical procedure to repair a dissecting aortic aneurysm (1,2). It is rarely used as a first-line surgical technique to reimplant coronary ostia in ascending aorta reconstruction (3). The Cabrol technique is often required when there is an anatomically fixed coronary ostia and scarring from previous operations, button calcifications, coronary aneurysms and/or coronary anomalies.…”

Section: Discussionmentioning

confidence: 99%

“…Although there are reports examining short-and long-term outcome data for the Cabrol technique, these studies are often hard to interpret due to a myriad of issues: the variability of underlying pathology, inconsistencies in reporting nonfatal complications, and patient selection bias toward more complex pathology and physiology (3). As a result, rates of interposition Dacron graft stenosis due to diverse pathology varies and has been reported to be as high as 44% and as low as 2%, although no kinking has been reported (9,10).…”

Section: Discussionmentioning

confidence: 99%

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Successful percutaneous coronary intervention of a thrombosed cabrol graft after intraoperative cardiac arrest

Moussa¹,

Bhindi²

2014

Curr Res Cardiol

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The Cabrol technique is used to reimplant coronary arteries after aortic root replacement using a Dacron graft interposed between the aortic root graft and the native coronary artery. Although stenosis of the coronary graft anastomosis has been described, the authors present a case involving acute graft closure due to kinking of the Cabrol graft treated with percutaneous coronary intervention and thrombectomy. A 68-year-old man with a history of Bentall repair was admitted with graft and aortic valve endocarditis. He underwent a repeat aortic root reconstruction using the Cabrol procedure for the reanastomosis of the right coronary and left main coronary artery (LMCA) to the aortic graft. He returned to the operating room 48 h later for repair of a leaking subannular pericardial patch. During this procedure, he experienced a cardiac arrest and Doppler ultrasonography demonstrated poor flow to the left coronary interposition graft.The patient was placed on extracorporeal membrane oxygenation and sent for urgent coronary angiography. Coronary angiography revealed a thrombosed Cabrol graft to the LMCA. Multiple rounds of thombectomy using the Pronto thrombectomy catheter re-established Thrombosis in Myocardial Infarction grade 3 flow and revealed a kink at the proximal end of the graft. Given the hemodynamic instability of the patient, a decision was made to treat the kink within the graft with percutaneous coronary intervention (PCI). The kinked segment was stented with 6.0 mm × 29 mm and 5.0 mm × 20 mm bare-metal stents in an overlapping fashion. This resulted in Thrombosis in Myocardial Infarction grade 3 flow within the graft and the entire left coronary system with improved hemodynamics. The present case is, to the authors' knowledge, the first to document a LMCA graft occlusion intraoperatively, resulting in cardiac arrest with successful reperfusion established by PCI. In conclusion, PCI is an effective technique to treat an acute occlusion of a Cabrol graft in a hemodynamically unstable patient. T he Cabrol technique is used to reimplant coronary arteries after aortic root replacement using a Dacron graft interposed between the aortic root graft and the native coronary artery. Although stenosis of the coronary graft anastomosis has been described previously, we present a case of acute graft closure due to kinking of the Dacron graft that was successfully treated with percutaneous coronary intervention (PCI) and thrombectomy. CASE PRESENTATIoNA 68-year-old man with a history of Bentall repair was admitted to hospital with graft and aortic valve endocarditis. He underwent a repeat aortic root reconstruction using the Cabrol procedure for the reanastomosis of the right coronary and left main coronary artery to the aortic graft. He returned to the operating room 48 h later for repair of a leaking subannular pericardial patch. During this procedure, he experienced a cardiac arrest and Doppler ultrasound demonstrated poor flow to the left coronary interposition graft. Soon thereafter, the patient was placed on ex...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successful percutaneous coronary intervention of a thrombosed cabrol graft after intraoperative cardiac arrest

Moussa¹,

Bhindi²

2014

Curr Res Cardiol

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“…Nevertheless, this technique may be associated with a higher rate of mortality and morbidity compared with modified Bentall reconstruction. In particular, both early and long-term results suggest that Cabrol reconstruction is inferior [2,20], intended for the left coronary ostium was trimmed to the appropriate length and sewn into place using a 5-0 Prolene running suture. The distal anastomosis to the native aorta was completed next, followed by completion of the anastomosis of the right branch graft to the right coronary button.…”

Section: Surgical Techniquementioning

confidence: 99%

“…For instance, Westaby and colleagues propose a technique using a "pericardial hood" extension added to the right coronary anastomosis ( Figure 3A) [14] to avoid kinking or tension, whereas others advocate the use of a coronary vein bypass interposed between the main aortic graft and the right coronary button [2]. The Cabrol reconstruction represents a more radical approach to the problem [19] and is meant to obviate the challenges of coronary reimplantation when mobilization of the coronaries is cumbersome [2,13,[17][18][19]. Nevertheless, this technique may be associated with a higher rate of mortality and morbidity compared with modified Bentall reconstruction.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Aortic root replacement (ARR) is a well-described and highly effective technique for treating aortic root pathologies with excellent long-term outcomes and reported mortality ranging between 4-10% in specialized aortic centers [1][2][3]. Coronary button reimplantation is arguably one of the most challenging aspects of ARR operations, requiring mobilization and reattachment of the coronaries to the root graft.…”

Section: Introductionmentioning

confidence: 99%

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Aortic Root Reconstruction with a New Dacron Graft Featuring Prefabricated Coronary Side Branches

Calcaterra¹,

Jazayeri²,

Parekh³

et al. 2017

aorta

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Background: Coronary button reimplantation can represent a technical challenge of aortic root reconstruction that can be associated with significant morbidity and mortality. With the goal of simplifying coronary reimplantation and reducing the incidence of related complications, we designed a new Dacron graft with prefabricated coronary branches to minimize coronary artery mobilization and prevent the potential mechanical complications of reattachment to the body of the graft. Methods: Between June 2010 and May 2012, we implanted the graft in eight patients (six males, two females) ranging in age from 42-68 years (mean, 54 years). Six procedures were modified Bentall reconstructions, and two procedures were valvesparing root replacements using the reimplantation technique. Results: There were no complications and no morbidity or mortality related to coronary reattachment. All patients were alive and doing well at a mean follow-up of 26 months (range, 17-38 months). At an extended mean follow-up of 42 months (range, 25-56 months), one patient died of stroke-related complications. No radiologic or clinical evidence of impairment of coronary perfusion was identified in any patient. Conclusions: The use of this new graft model may simplify the technique of root reconstruction and potentially lower the incidence of mechanical complications related to coronary button reimplantation.

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Surgery for detached coronary ostial anastomosis 21 years post-Bentall procedure

2014

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Though a high frequency of postoperative complications after an original Bentall procedure has been reported, several procedures that reduce the incidence of complications have been developed. Complications relating to anastomoses of the interposed graft are infrequent but life-threatening. This report describes a case of a 61-year-old man who presented with heart failure secondary to bilateral detachment of coronary ostial anastomoses and graft stenosis 21 years after undergoing a modified Bentall procedure. These complications were successfully repaired by reconstructing the conduit and coronary arteries.

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Evolution and Current Applications of the Cabrol Procedure and Its Modifications

Cited by 49 publications

References 35 publications

Successful percutaneous coronary intervention of a thrombosed cabrol graft after intraoperative cardiac arrest

Successful percutaneous coronary intervention of a thrombosed cabrol graft after intraoperative cardiac arrest

Aortic Root Reconstruction with a New Dacron Graft Featuring Prefabricated Coronary Side Branches

Surgery for detached coronary ostial anastomosis 21 years post-Bentall procedure

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