Successful percutaneous coronary intervention of a thrombosed cabrol graft after intraoperative cardiac arrest

Abstract

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...