Medium And Long Term Efficacy Of Improved Cabrol Technique In Aortic Root Replacement And Etiology Of Postoperative Complications

Objective:The Cabrol technique was independently improved in patients with simple aortic root tumors and aortic dissection involving aortic root in the department of cardiac macrovascular surgery,yanan hospital,kunming.the medium and long term curative effect and The causes of postoperative complications were analyzed to prove the superiority of this methodMethods:Previous studies and reports from our department have confirmed that our self-developed Cabrol technology is safe and feasible,on the basis of this study,The clinical data of 204 patients with simple aortic root tumors and 67 patients with aortic dissection involving aortic root who underwent aortic root replacement using modified Cabrol technique were retrospectively analyzed from January 2011 to January 2020.Follow-up was performed at the clinic and by telephone,The follow-up rate was 90.77%up to January 2020.Further follow-up was conducted to observe the intraoperative and long-term efficacy,and the causes of related complications and death were analyzed.SPSS-22.0 was used for statistical analysis of the data.Results:A total of 271 patients were treated with a modified Cabrol technique;Male:220 cases(81.2%),female:51 cases(18.9%),age:17 to 70 years old,mean age:49.0±11.9 years old,Simple aortic root tumor:204 cases(78.8%),Aortic dissection:67 cases(21.2%),including Ⅰ aortic dissection,Ⅱ aortic dissection,the aortic root type Ⅲ aortic dissection with tumor of 57 cases,7 cases,3 cases respectively;Left and right open coronary artery transplantation with improved Cabrol technique:140 cases(51.7%),Left open coronary artery transplantation using modified Cabrol technique:113 cases(41.7%),Right open coronary artery transplantation with improved Cabrol technique:18 patients(6.6%).9 patients(6 patients with aortic dissection)died in hospital after operation:Three patients died due to low cardiac output syndrome.Due to root bleeding after stopping circulation,1 case died of myocardial ischemia after right coronary artery was involved in the process of hemostasis.2 cases died of cerebral hemorrhage and 3 cases died of multifunctional organ failure.8 cases of out-of-hospital death(5 cases of aortic dissection):1 case died of cerebral hemorrhage and 1 case died of multiple organ failure 1 month after surgery.One patient died of infective endocarditis 6 months after surgery.One patient died of unknown causes 1 year after surgery.One patient died of cerebral infarction 2 years later.Two patients died of cerebral hemorrhage 3 years after operation.5 years later,1 case of unexplained death occurred,which was an elderly follow-up patient.Aortic dissection accounted for 64.71%of all deaths,cox regression analysis of related factors,aortic dissection was associated with postoperative death and related complications,However,there was no direct correlation with the method of coronary artery opening transplantation using artificial vessel.The 1-year,3-year,6-year and 9-year survival rates were 95.6%,92.2%,88.3%and 88.3%,respectively.Postoperative neurological injury symptoms and related manifestations caused by irregular warfarin use are common postoperative complications,Among the 271 patients who were followed up,there were 46 patients with neurological injury symptoms after surgery,and the symptoms were relieved and gradually recovered within 3 months after surger;24 cases(6 deaths)were associated with irregular warfarin use.Cardiac color doppler ultrasound was reviewed after surgery,the cardiac function of 97.96%of the patients was significantly improved compared with that before surgery,and no patients with further deterioration of cardiac function were found after surgery.In the postoperative double source CT results,only one case was found to have different degrees of tumor-like dilatation from the left and right coronary artery openings to the distal end one year after the operation.no further dilatation was found in the tumor during the continuous follow-up.no significant changes were observed in the cardiac echocardiography,At present,the patient was followed up and survived,the patient is marfan syndrome,which is considered to be followed up and survived,the patient is marfan syndrome,which is considered to be related to vascular lesions.No coronary artery stenosis or thromboembolism was found in the remaining patients.Conclusion:Through the analysis of the follow-up results and the comparison with the relevant literature in recent years,the application of Cabrol technique in aortic root replacement is relatively simple,the efficacy of medium and long-term treatment is positive.Long-term review of dual-source CT and cardiac color doppler ultrasound did not find coronary artery stenosis and thromboembolism related manifestations.Through the analysis of related complications and causes of death,the results showed that there was no direct correlation with the open coronary artery transplantation using the artificial vessel,it further proves the superiority of the curative effect of this operation.