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Ann Thorac Surg 2003;75:126-131
© 2003 The Society of Thoracic Surgeons
a Department of Cardiovascular Sciences, Ospedale "S. Maria Della Misericordia," Udine, Italy
Accepted for publication August 9, 2002.
* Address reprint requests to Dr Gelsomino, U. O. Cardiotoracica, Azienda Ospedale "S. Maria della Misericordia," Piazzale S. Maria Della Misericordia 11, 33100 Udine, Italy.
e-mail: sandrogelsomino{at}virgilio.it
BACKGROUND: Little information exists regarding the long-term results of the Cabrol technique. This study aimed at exploring, over a 16-year period, the results of aortic root replacements employing this procedure.
METHODS: Between 1986 and 2002 forty-five patients (mean age 58.7 ± 13.8 years old, 84.4% male) underwent a Cabrol procedure. Aortic dissection was the most frequent cause of aortic disease in this series (n = 17), followed by annuloaortic ectasia (n = 10), atherosclerotic aneurysm (n = 5) and poststenotic dilatation (n = 5). Six patients (13.4%) had undergone a previous aortic operation, 8 (17.7%) had a Marfan syndrome and five (11.1%) underwent concomitant arch replacement. Mean clinical follow-up was 87.3 ± 24.3 months. Twenty-eight patients (93.3% of survivors) had a transesophageal echocardiography (TEE) performed at a mean of 64 ± 32 months postoperatively.
RESULTS: Early mortality was 20%. It was 9.1% for patients with an ascending aortic aneurysm and 41.2% for dissections (p = 0.026). Independent multivariate predictors of early mortality were: aortic dissection (p = 0.009), emergency operation (p < 0.001), operative year (p = 0.02), cross-clamp time (p = 0.001), and CPB duration (p < 0.001). Actuarial survival was 0.77 ± 0.06, 0.72 ± 0.06, 0.59 ± 0.04 and 0.59 ± 0.04 at 1, 5, 10, and 16 years, respectively. Multivariate analysis revealed age (p = 0.007), cross-clamp time (p = 0.0006) and CPB duration (p = 0.009) as strong predictors of poor late survival. A periprosthetic jet with significant valve regurgitation was detected by TEE in 3 patients. In one of them, an infected periprosthetic space-right ventricular fistula was demonstrated requiring reoperation. Altogether, freedom from reoperation and endocarditis at 16 years was 0.97 ± 0.02 and 0.94 ± 0.03, respectively.
CONCLUSIONS: The Cabrol technique demonstrated a nonnegligible incidence of early and long-term complications. It should be rarely used and only when a "button" technique is not feasible.
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