Aortic root replacement with a composite graft*Factors influencing immediate and long-term results

Bachet, Jean; Termignon, J. L.; Goudot, B; Dreyfus, Gilles; Piquois, A; Brodaty, D; Dubois, Claude; Delentdecker, Philippe; Guilmet, D

doi:10.1016/s1010-7940(96)80298-3

Cited by 68 publications

(56 citation statements)

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“…The Bentall procedure using a button technique for aortic root replacement is safe and durable with a low mortality rate and high reoperation-free rate in patients with dystrophic aneurysm or Marfan syndrome. 7,8 In the present patient, Bentall operation using button technique should have been performed initially; however, only a few reports have described reoperation after the Bentall procedure for aortitis syndrome. 9,10 In patients with the aortitis syndrome, the potential risk of anastomotic dehiscence is much higher than in patients with dystrophic aneurysm or Marfan syndrome, even in the inactive phase of the inflammation.…”

Section: Discussionmentioning

confidence: 80%

“…Either Cabrol's technique or Piehler's technique must be used when the Carrel or original Bentall reimplantation is not feasible; for example, during redo procedures. 7,10 In the present patient, redo graft replacement of the ascending aorta was chosen instead of reimplantation of a new composite valved graft because of the fragile aortic root and it was a simpler procedure. The translocated Bentall procedure may be an alternative technique for composite graft detachment.…”

Section: Discussionmentioning

confidence: 99%

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Reoperation for Ascending Aortic Aneurysm, Coronary Ostial Aneurysm and Patent Cabrol Trick After Bentall Operation for Aortitis Syndrome

Shiono

Hata

Sezai

et al. 2005

Circ J

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ortitis is chronic inflammation of the aorta, its branches and the pulmonary artery that leads to stenosis/occlusion or dilatation. Cardiovascular complications, such as aortic regurgitation and aneurysmal dilatation of the aortic root, can be fatal. The most serious complication after aortic valve replacement (AVR) or root reconstruction for aortitis syndrome is dehiscence of the anastomotic site. We report a patient with aortitis syndrome associated with ulcerative colitis who underwent the Bentall operation for annuloaortic ectasia and aortic regurgitation, but required reoperation for anastomotic dehiscence 9 years later. Case ReportA 38-year-old woman with aortitis syndrome associated with ulcerative colitis underwent an original Bentall operation for annuloaortic ectasia with severe aortic insufficiency in December 1995. At the time of initial operation a composite Dacron graft with a 27-mm mechanical valve was used, and both coronary ostia were directly anastomosed to the composite valved graft, which was wrapped with the native aortic wall, together with interposition using a tube graft between the aorta and right atrium (Cabrol trick). Pathology revealed low-grade inflammation of the aortic wall with interrupted elastic fibers, which was compatible with a diagnosis of aortitis (Fig 1). The patient was well until 5Circulation Journal Vol.69, July 2005 years later when she had shortness of breath and anemia (Fig 2). Preoperative chest computed tomography and angiography revealed a patent Cabrol trick, aneurysmal dilatation of the ascending aorta and aortic arch around the artificial graft, coronary ostial aneurysms, and paravalvular leakage (Fig 3). She had a history of steroid therapy for the ulcerative colitis.At the time of reoperation, dense adhesions were found especially around the Cabrol trick and the ascending aorta was dilated more than 60 mm. The femoral artery was cannulated for arterial perfusion. Two-staged venous cannulation was carried out through a small right atriotomy. After implementation of cardiopulmonary bypass, the ascending aorta was cross-clamped obliquely beyond the distal anastomotic site of the previous graft. After clamping the Cabrol trick, aortotomy of the dilated ascending aorta and Dacron graft revealed that the internal aortic wall was normal color and that the native aortic wall around both coronary ostia was dilated. Cold crystalloid cardioplegic solution was antegradely administered through both coronary ostia. Anastomotic dehiscence was found at the distal anastomosis of the Dacron graft and at the non-coronary cusp site of the proximal composite graft, but not at either of the coronary ostia (Fig 4). The primary dehiscence was considered to be the distal site of the graft, resulting in aneurysmal dilatation of the wrapped aorta. Paravalvular leakage was considered to have begun 5 years after the initial operation when the inflammation deteriorated (Fig 2).The Dacron graft was totally removed, leaving intact the sewing ring of the mechanical valve. A new 30-mm Dacron ...

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Reoperation for Ascending Aortic Aneurysm, Coronary Ostial Aneurysm and Patent Cabrol Trick After Bentall Operation for Aortitis Syndrome

Shiono

Hata

Sezai

et al. 2005

Circ J

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“…The graft is attached to the aortic root using an end-to-side technique and to the coronary ostia using an end-to-end technique (5). The mortality rate has been reported to be as high as 20%, which is significantly higher than other aortic repair techniques (6). This may be due to the meticulous nature of the Cabrol procedure and the choice of method for the mobilization and reimplantation of the coronary artery ostia during complex composite graft replacement of the aorta.…”

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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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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“…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%

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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Aortic root replacement with a composite graft*Factors influencing immediate and long-term results

Cited by 68 publications

References 0 publications

Reoperation for Ascending Aortic Aneurysm, Coronary Ostial Aneurysm and Patent Cabrol Trick After Bentall Operation for Aortitis Syndrome

Reoperation for Ascending Aortic Aneurysm, Coronary Ostial Aneurysm and Patent Cabrol Trick After Bentall Operation for Aortitis Syndrome

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

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