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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
A long-term experience with the Cabrol root replacement technique for the management of ascending aortic aneurysms
Sandro Gelsomino1, Romeo Frassani, Paolo Da Col
1Department of Cardiovascular Sciences, Ospedale S. Maria Della Misericordia, Udine, Italy. sandrogelsomino@virgilio.it
Insights
The Cabrol technique for aortic root replacement has significant early and long-term complications. This aortic surgery should be reserved for cases where the button technique is not feasible.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Background:
- Limited data exists on the long-term outcomes of the Cabrol technique for aortic root replacement.
- This study evaluates the 16-year results of this specific aortic procedure.
Purpose of the Study:
- To assess the long-term efficacy and safety of the Cabrol technique in aortic root replacement.
- To identify predictors of early and late mortality and complications associated with the Cabrol procedure.
Main Methods:
- A retrospective analysis of 45 patients undergoing the Cabrol procedure between 1986 and 2002.
- Data collected included patient demographics, indications for surgery, operative details, and clinical follow-up.
- Transesophageal echocardiography (TEE) was used to assess postoperative aortic valve function and periprosthetic complications.
Main Results:
- The early mortality rate was 20%, with higher rates for aortic dissection (41.2%) compared to ascending aortic aneurysm (9.1%).
- Independent predictors of early mortality included aortic dissection, emergency operation, operative year, cross-clamp time, and cardiopulmonary bypass (CPB) duration.
- Actuarial survival at 16 years was 59%. Age, cross-clamp time, and CPB duration predicted poor late survival. Freedom from reoperation and endocarditis at 16 years was high (0.97 and 0.94, respectively).
Conclusions:
- The Cabrol technique is associated with a considerable rate of early and late complications.
- This aortic root replacement method should be used sparingly, primarily when the button technique is not a viable option.
Background:
Little information exists regarding the long-term results of the Cabrol technique. This study aimed at exploring, over a 16-year period, the results of aortic root replacements employing this procedure.
Methods:
Between 1986 and 2002 forty-five patients (mean age 58.7 +/- 13.8 years old, 84.4% male) underwent a Cabrol procedure. Aortic dissection was the most frequent cause of aortic disease in this series (n = 17), followed by annuloaortic ectasia (n = 10), atherosclerotic aneurysm (n = 5) and poststenotic dilatation (n = 5). Six patients (13.4%) had undergone a previous aortic operation, 8 (17.7%) had a Marfan syndrome and five (11.1%) underwent concomitant arch replacement. Mean clinical follow-up was 87.3 +/- 24.3 months. Twenty-eight patients (93.3% of survivors) had a transesophageal echocardiography (TEE) performed at a mean of 64 +/- 32 months postoperatively.
Results:
Early mortality was 20%. It was 9.1% for patients with an ascending aortic aneurysm and 41.2% for dissections (p = 0.026). Independent multivariate predictors of early mortality were: aortic dissection (p = 0.009), emergency operation (p < 0.001), operative year (p = 0.02), cross-clamp time (p = 0.001), and CPB duration (p < 0.001). Actuarial survival was 0.77 +/- 0.06, 0.72 +/- 0.06, 0.59 +/- 0.04 and 0.59 +/- 0.04 at 1, 5, 10, and 16 years, respectively. Multivariate analysis revealed age (p = 0.007), cross-clamp time (p = 0.0006) and CPB duration (p = 0.009) as strong predictors of poor late survival. A periprosthetic jet with significant valve regurgitation was detected by TEE in 3 patients. In one of them, an infected periprosthetic space-right ventricular fistula was demonstrated requiring reoperation. Altogether, freedom from reoperation and endocarditis at 16 years was 0.97 +/- 0.02 and 0.94 +/- 0.03, respectively.
Conclusions:
The Cabrol technique demonstrated a nonnegligible incidence of early and long-term complications. It should be rarely used and only when a "button" technique is not feasible.
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