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Yang S, Zhang YY, Zi YF, Pu L, Qian X, Ren L, Li YB, Jin ZH, Liu JF, Yuan Z, Li YX. Cabrol procedure and its modifications: a systematic review and meta-analysis. J Cardiothorac Surg 2024; 19:153. [PMID: 38532449 DOI: 10.1186/s13019-024-02642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/11/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND The Cabrol procedure has undergone various modifications and developments since its invention. However, there is a notable gap in the literature regarding meta-analyses assessing it. METHODS A systematic review and meta-analysis was conducted to evaluate the effectiveness and long-term outcomes of the Cabrol procedure and its modifications. Pooling was conducted using random effects model. Outcome events were reported as linearized occurrence rates (percentage per patient-year) with 95% confidence intervals. RESULTS A total of 14 studies involving 833 patients (mean age: 50.8 years; 68.0% male) were included in this meta-analysis. The pooled all-cause early mortality was 9.0% (66 patients), and the combined rate of reoperation due to bleeding was 4.9% (17 patients). During the average 4.4-year follow-up (3,727.3 patient-years), the annual occurrence rates (linearized) for complications were as follows: 3.63% (2.79-4.73) for late mortality, 0.64% (0.35-1.16) for aortic root reoperation, 0.57% (0.25-1.31) for hemorrhage events, 0.66% (0.16-2.74) for thromboembolism, 0.60% (0.29-1.26) for endocarditis, 2.32% (1.04-5.16) for major valve-related adverse events, and 0.58% (0.34-1.00) for Cabrol-related coronary graft complications. CONCLUSION This systematic review provides evidence that the outcomes of the Cabrol procedure and its modifications are acceptable in terms of mortality, reoperation, anticoagulation, and valve-related complications, especially in Cabrol-related coronary graft complications. Notably, the majority of Cabrol procedures were performed in reoperations and complex cases. Furthermore, the design and anastomosis of the Dacron interposition graft for coronary reimplantation, considering natural anatomy and physiological hemodynamics, may promise future advancements in this field.
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Affiliation(s)
- Sen Yang
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ya-Yong Zhang
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yun-Feng Zi
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Lei Pu
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xu Qian
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Le Ren
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yong-Bo Li
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhi-Hao Jin
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jian-Feng Liu
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhuo Yuan
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ya-Xiong Li
- Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
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Oh S, Kim JH, Hyun DY, Cho KH, Kim MC, Sim DS, Hong YJ, Ahn Y, Jeong MH, Jung Y. Case Report: Intravascular Ultrasound-guided Intervention for Anastomosis Stenosis of the Left Main Coronary Artery Post-Cabrol Technique. Front Cardiovasc Med 2022; 9:778815. [PMID: 35310967 PMCID: PMC8926074 DOI: 10.3389/fcvm.2022.778815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/08/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Some cases of percutaneous coronary intervention (PCI) for the anastomotic site between the Cabrol-type conduit and the left main coronary artery (LMCA) have been reported. Nevertheless, the combination of PCI with a detailed description of lesion appearance using virtual histology-intravascular ultrasound (VH-IVUS) has never been reported. In this study, we present a case of acute myocardial infarction that was successfully treated with intravascular ultrasound (IVUS)-guided PCI for focal stenosis at the anastomotic site, and the plaque composition was studied in detail. Case Presentation A 35-year-old Korean male with Behçet's disease was diagnosed with acute myocardial infarction. He had previously undergone three cardiothoracic surgeries including two aortic replacements, followed by modified Bentall operation with a Cabrol-type aortocoronary anastomosis. Coronary angiogram (CAG) showed focal critical stenosis at the anastomosis site between the conduit and the LMCA, and VH-IVUS showed fibrotic plaque with mainly fibrous tissue but without a confluent necrotic core. PCI was performed using a drug-eluting stent (4.5 × 12 mm, SynergyTM, Boston Scientific, Marlborough, MA, USA). Since a repeat CAG and IVUS post-surgery showed an under-expanded stent strut, post-dilation ballooning was additionally performed. Subsequently, the repeat IVUS revealed wellapposed and optimized deployment of the drug-eluting stent with full lesion coverage. Final CAG showed optimal angiographic results. After successful PCI, the patient's anginal symptoms improved dramatically, and he was successfully discharged from our hospital. Conclusion This study presents an IVUS-guided PCI case for an anastomotic site between the conduit and the LMCA. It is the first to investigate the characteristics of this lesion through VH-IVUS, which demonstrated the presence of fibrous plaques at the anastomotic site. IVUS radiofrequency data allow for a detailed assessment of plaque composition and provide new insights into the histopathological nature of stenotic lesions at the anastomotic site, especially in patients with chronic inflammatory diseases like Behçet's disease.
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Affiliation(s)
- Seok Oh
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, South Korea
- *Correspondence: Ju Han Kim
| | - Dae Young Hyun
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Yochun Jung
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Gwangju, South Korea
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Ahmed T, Alhazmi L, Latif AA, Arbune A, Sekela M, Leventhal A. Percutaneous intervention of Cabrol graft-left main anastomosis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 40S:235-238. [DOI: 10.1016/j.carrev.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/20/2022] [Accepted: 03/04/2022] [Indexed: 11/03/2022]
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Fukui T, Ogasawara N, Hasegawa S. Dynamic kinking of right coronary artery after the button Bentall procedure. BMJ Case Rep 2021; 14:14/1/e239128. [PMID: 33509885 PMCID: PMC7845688 DOI: 10.1136/bcr-2020-239128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Postoperative coronary artery complications after Bentall procedures are well recognised but are rare and potentially fatal. There have been only five cases documenting percutaneous coronary intervention (PCI) for right coronary artery (RCA) involvements after button Bentall procedures. We describe a case of postoperative silent myocardial ischaemia in a 72-year-old man who underwent the button Bentall procedure for a right sinus of Valsalva aneurysm. On postoperative day 15, an RCA complication was incidentally detected by follow-up multidetector CT. Coronary angiography showed proximal RCA kinking, which was not an anastomosis but a native coronary artery. The patient underwent a successful PCI with drug-eluting stent implantation. We reviewed six cases consisting of this case and five previous cases treated with PCI. These cases enhance the recognition of potential RCA complications after the button Bentall procedure.
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Affiliation(s)
- Tomoki Fukui
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Nobuyuki Ogasawara
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Shinji Hasegawa
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
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Fukuda K. Percutaneous intervention for an occluded left Cabrol graft. J Cardiol Cases 2019; 20:205-208. [PMID: 31762834 DOI: 10.1016/j.jccase.2019.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/03/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022] Open
Abstract
Percutaneous intervention for surgical reconstruction of a coronary artery is a challenging and complex procedure for interventional cardiologists. Particularly in settings of acute coronary syndrome, urgent revascularization may be critical for the prognosis of patients. Therefore, it is important that physicians have knowledge of various surgical techniques for coronary reconstruction. The Cabrol procedure is one of the surgical techniques after aortic root replacement, but it is rarely used at present. Here we describe a case of successful percutaneous revascularization for an occluded left Cabrol graft in acute ST-elevation myocardial infarction with cardiogenic shock. <Learning objective: Percutaneous intervention for surgical reconstruction of coronary artery is challenging. In coronary artery reconstruction, computed tomography angiography might be extremely useful. We describe a case of successful percutaneous revascularization for the occluded left Cabrol graft.>.
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Affiliation(s)
- Keisuke Fukuda
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori, Kishiwada, Osaka, 596-0042, Japan
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Vyas R, Mahmood S, Syed MA, Alhazmi L, Grande R. Long-Term Postoperative Complication of the Cabrol Procedure Presenting as Recurrent Anterior ST-Segment Elevation Myocardial Infarction. CASE 2019; 3:220-226. [PMID: 31709374 PMCID: PMC6833128 DOI: 10.1016/j.case.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Development of fistulae between the aneurysm sac and aortic graft can be a potential source of thrombi in patients treated with surgical aortic root replacement. Transesophageal echocardiography is an effective tool to assess post-operative complications of the Cabrol procedure. Post-operative complications of the Cabrol procedure can have a very delayed initial presentation.
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Tsuji M, Kodera S, Oshima T, Uehara M, Kiyosue A, Ando J, Watanabe M, Yamauchi H, Ono M, Komuro I. Coronary Artery Perforation During Percutaneous Coronary Intervention in a Patient with a Prior Modified Bentall Procedure. Int Heart J 2018; 59:848-853. [DOI: 10.1536/ihj.17-357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Masaki Tsuji
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Tsukasa Oshima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masae Uehara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Arihiro Kiyosue
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Jiro Ando
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masafumi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Haruo Yamauchi
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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Kourliouros A, Soni M, Rasoli S, Grapsa J, Nihoyannopoulos P, O'Regan D, Athanasiou T. Evolution and Current Applications of the Cabrol Procedure and Its Modifications. Ann Thorac Surg 2011; 91:1636-41. [DOI: 10.1016/j.athoracsur.2011.01.061] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 01/16/2011] [Accepted: 01/20/2011] [Indexed: 11/25/2022]
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Jang WI, Jeong JO, Ahn KT, Park HS, Park JH, Kim SS, Lee JH, Choi SW, Seong IW. A successful primary percutaneous coronary intervention twelve days after a cabrol composite graft operation in marfan syndrome. Korean Circ J 2010; 40:247-50. [PMID: 20514337 PMCID: PMC2877791 DOI: 10.4070/kcj.2010.40.5.247] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 11/02/2009] [Accepted: 11/02/2009] [Indexed: 11/17/2022] Open
Abstract
The Cabrol procedure is one of several techniques used for re-implantation of a coronary artery. After replacement of the ascending aorta and aortic valve using a composite graft, second Dacron tube grafts are used for anastomosis between the ascending aortic graft and the coronary arteries. Ostial stenosis is one of the complications associated with the Cabrol operation. However, there have been no reported cases of acute thrombosis of a Cabrol graft. Here we report a case with acute ST elevation myocardial infarction due to thrombotic total occlusion of a right Cabrol graft-to-right coronary artery (RCA) twelve days after surgery in a patient with Marfan syndrome. He was successfully treated with primary percutaneous coronary intervention (PCI).
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Affiliation(s)
- Won Il Jang
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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Percutaneous intervention of Cabrol graft-left main anastomosis during acute myocardial infarction. Int J Cardiol 2010; 140:e27-9. [PMID: 19108906 DOI: 10.1016/j.ijcard.2008.11.073] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 11/15/2008] [Indexed: 11/21/2022]
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 graft-coronary anastomosis has been described, there have been few reports of percutaneous intervention to these stenoses. An understanding of the Cabrol technique and its associated anatomical considerations is essential for invasive cardiologists, as they may encounter patients who have undergone this procedure. We report a case of emergent percutaneous intervention to a Cabrol graft-left main anastomosis in a patient who presented with acute myocardial infarction complicated by cardiogenic shock.
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Angina, an Unusual and Late Complication of the Cabrol Procedure: A Case Report and Review of the Literature. Am J Med Sci 2008; 335:151-3. [PMID: 18277126 DOI: 10.1097/maj.0b013e3180a6f13b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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