Feasibility and Durability of the Modified Cabrol Coronary Artery Reattachment Technique
| Autor: | Madiha Hassan, Zain Al-Rstum, Akiko Tanaka, Anthony L. Estrera, Hazim J. Safi, Nicolas Zhou, Charles C. Miller, Harleen K. Sandhu |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Aortic root 030204 cardiovascular system & hematology Cabrol technique Stratified analysis Blood Vessel Prosthesis Implantation 03 medical and health sciences Postoperative Complications 0302 clinical medicine Humans Medicine Survival rate Retrospective Studies Aortic dissection business.industry Operative mortality Middle Aged medicine.disease Coronary Vessels Aortic Aneurysm Blood Vessel Prosthesis Surgery Survival Rate Coronary arteries Aortic Dissection Treatment Outcome medicine.anatomical_structure 030228 respiratory system Replantation Feasibility Studies Female Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | The Annals of Thoracic Surgery. 110:1847-1853 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2020.04.125 |
| Popis: | This study evaluated the feasibility and durability of the modified Cabrol coronary reattachment technique after aortic root replacement.The study retrospectively reviewed 370 patients who underwent aortic root replacement, during 1991 and 2018, and who were separated into 2 groups: a modified Carol (mCabrol) group (n = 84), consisting of patients with 1 or both coronary ostia reimplanted using a modified Cabrol technique; and a Carrel group (n = 286), consisting of patients with both coronary ostia reimplanted using the Carrel button technique.Baseline characteristics were similar in the 2 groups, except the mCabrol group had higher rates of redo sternotomy (74% vs 16%), chronic aortic dissection (58% vs 19%), and infection (14% vs 3%). In the mCabrol group, 60% had both coronary arteries reattached with the technique, and 40% of the procedures were unilateral. Operative mortality was significantly higher in mCabrol group compared with the Carrel group. However, in the stratified analysis for resternotomy, operative mortality between 2 groups were similar (16% vs 13%; P = .786). The survival rate at 5 years and 10 years was 68 ± 6% and 44 ± 6%, respectively, in the mCabrol group and 87 ± 2% and 80 ± 3%, respectively, in the Carrel group (log-rank P.001). After propensity adjustment, chronic kidney disease and prior coronary artery bypass grafting, but not the modified Cabrol technique, were independent predictors of both operative mortality and follow-up mortality (operative, P = .518; follow-up, P = .080). A total of 47 (66%) of 71 discharged patients in the mCabrol group had follow-up imaging, and no Cabrol graft was occluded. Two patients in the mCabrol group required interventions related to the reattachment technique: 1 coronary ostial anastomosis stenosis and 1 graft-to-graft anastomosis pseudoaneurysm.The modified Cabrol reattachment technique was not predictive of increased mortality and has excellent patency. |
| Databáze: | OpenAIRE |
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