[Aortic root replacement employing Cabrol and Piehler techniques]

Between February, 1982, and September, 1994, 24 patients underwent aortic root replacement using a valve-bearing composite graft and coronary perfusion grafts. The indications for surgery were annulo-aortic ectasia in 21 patients, and aortic dissection associated with significant aortic regurgitation in 3 patients. Aortic root was reconstructed employing the techniques described by Cabrol and colleagues (Cabrol operation) in 16, and by Piehler and Pluth (Piehler operation) in 8. Two of 16 patients who underwent Cabrol operation required concomitant procedures. Four patients (25.0%) who underwent Cabrol operation had technical troubles relating to coronary reattachements (kinking and torsion of coronary grafts in 2, obstruction of left limb of coronary graft in 1, and coronary graft compression by aortic wall wrapping in 1), while one patient (12.5%) having Piehler operation had coronary graft compression by partial wrapping of aortic root. The hospital deaths occurred in 4 patients undergone Cabrol operation, with the hospital mortality rate being 16.7%. Three patients including 2 with concomitant procedures died of low cardiac output and one died of rupture of residual dissecting aneurysm of the aortic arch. No pseudoaneurysm nor anastomotic stenosis was observed in any hospital survivors. Late deaths occurred in 5 patients, in whom there was no late complication relating to coronary reconstruction. However, late obstruction of left ostial stenosis developed in one patient who underwent Piehler operation, which required coronary artery bypass. We conclude that aortic root replacement using coronary perfusion grafts provides sound coronary anastomoses without late pseudoanurysm. Coronary reattachments is facilitated by use of Piehler technique, preventing coronary graft kinking or torsion. Late coronary ostial stenosis should be considered as a possible cause of fatal myocardial infarction and sudden death, and careful follow-up is required for patients having these kinds of operation for the prevention of late cardiac events.