Intermediate And Long-term Follow-up Study On The Application Of Improved Cabrol Procedure In Aortic Root Replacement

Objective:To evaluate the intermediate and long-term therapeutic efficacy of improved Cabrol procedure that independently modified by the Cardiovascular Department of Yan-an Hospital of Kunming city in the treatment of aortic root aneurysm and Stanford A aortic dissection-with involvement of aortic root.Methods:The clinical data of 101 aortic root replacement cases received improved Cabrol procedure were retrospectively analyzed.Improved Cabrol procedure involves coronary artery ostial transplantation with intermediate artificial blood vessels.And the length of the artificial blood vessel is about 0.4cm and the diameter is 0.8 or 1.0cm.All patients were followed-up in an outpatient clinic or by a telephone interview until January 2018,with a duration from 6 months to 7 years.Total follow-up duration is 2178 months and 11 patients were lost to follow-up,with a follow-up rate being 89.1%.All data were analyzed with SPSS-20.Results:Of 101 patients treated with improved Cabrol procedure,there were 77 male(76.2%)and 24 female(23.8%)patients,with an average age of 48.7±10.8 years,ranging from 18 to 70 years.There were 73 cases of aortic root aneurysm(72.3%)and 28 cases of aortic dissection(AD)(27.7%).Improved Cabrol procedure were performed respectively in 30 patients with both left and right coronary artery ostia(29.7%),64 patients with left coronary artery ostia(63.4%)and 7 patients with right coronary artery ostia(6.9%).Dual-source computed tomography(CT)and transthoracic echocardiography(TTE)were performed after surgery,and no ostial stenosis was found.There was only 1 case of different degrees of aneurysmal dilatation,from the orifice to distal end of both left and right coronary artery.After surgery,no hospital death was noticed but there were 4 deaths with 30 days:2 from cerebral hemorrhages and 2 from multiorgan dysfunction.And 1 patient died of endocarditis 6 months after surgery and 1 died of unknown reason 1 year after surgery.Moreover,1 died of cerebral infarction 2 years after surgery.The survival rate of 1 year,3years,and 6years were 93.0±0.03%,87.8±0.06%and 87.8±0.06%,respectively.Conclusion:The improved Cabrol procedure independently modified by our department is relatively simple in the aortic root replacement surgery.We concluded that it is safe and feasible to perform improved Cabrol procedure in cases with slight ostial displacement of coronary artery(the distance between coronary artery ostia and aortic annulus is less than 1cm)or small aortic root,and the intermediate and long-term therapeutic efficacy are favorable.