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[Operative results of total replacement of the ascending aorta and aortic valve--characteristic difference between
K Miyahara1, M Kawase, E Mannouji
1Division of Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Insights
The Cabrol procedure for aortic valve and ascending aorta replacement showed shorter operation times and fewer late complications compared to the Bentall procedure. This suggests Cabrol
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Background:
- Ascending aorta and aortic valve replacement are complex procedures.
- The Bentall and Cabrol procedures are established surgical techniques for these repairs.
Purpose of the Study:
- To compare the outcomes of the Bentall procedure versus the Cabrol procedure for total replacement of the ascending aorta and aortic valve.
- To evaluate operative times, mortality, and long-term complication rates between the two surgical approaches.
Main Methods:
- A retrospective study comparing 15 patients undergoing the Bentall procedure (group B) and 11 patients undergoing the Cabrol procedure (group C).
- All patients underwent total replacement of the ascending aorta and aortic valve using an inclusion technique.
- Data collected included operative time, aortic cross-clamp time, operative mortality, late mortality, and complication rates.
Main Results:
- The Cabrol procedure (group C) had significantly shorter operation times (p < 0.05) and aortic cross-clamp times (p < 0.01) compared to the Bentall procedure (group B).
- Operative mortality was 0% for group B and 1 (6.7%) for group C. Late mortality occurred in 2 patients (13.3%) in group B.
- Late complication rates were significantly lower in the Bentall group (p < 0.05), with fewer instances of coronary-graft anastomotic leakage, pseudoaneurysm, hematoma, and distal anastomotic leakage observed in the Cabrol group.
Conclusions:
- Both Bentall's and Cabrol's procedures yield satisfactory results for ascending aorta and aortic valve replacement.
- The Cabrol procedure demonstrated advantages including shorter operative times and a trend towards fewer postoperative complications.
- Further investigation may be warranted to fully elucidate the long-term benefits and optimal application of each technique.
Abstract:
From May 1979 to November 1991, 26 patients underwent total replacement of the ascending aorta and aortic valve. We employed 15 Bentall's procedure (group B) and 11 Cabrol's procedure (group C). There were no significant difference in age and etiology between the two groups. Inclusion technique was used in all patients. Compared group B with group C, both the operation time and the aortic cross-clamp time were significantly shorter in group C than in group B. (p < 0.05, p < 0.01 respectively). There were no operative death in group B and one in group C. There were two death in group B in later postoperative period. One was due to the anastomotic leakage at the distal site with infection, and the other was cardiac death caused by the infectious fistula between wrapping cavity and RA. The postoperative actuarial survival rate for group B at 12.8 years was 86.7% and that for group C at 5.1 years was 90.9%. The late complications such as coronary-graft anastmotic leakage or pseudoaneurysm, hematoma between the wrap and the graft and anastomotic leakage at the distal site were recognized more in group B. In group C no pseudoaneurysm were noted, but hematoma was noted in two patients. The rate of complications in late phase was significantly lower in group B (p < 0.05). Although as a procedure of total replacement of the ascending aorta and aortic valve both Bentall's and Cabrol's procedure represent satisfactory operative results, Cabrol's procedure has some advantages and fewer postoperative complications.(ABSTRACT TRUNCATED AT 250 WORDS)