Left main stem coronary stenosis associated with Cabrol grafting

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Excerpt

The Bentall's procedure is the replacement of the aortic root and aortic valve using a composite material graft alongside a prosthetic aortic valve.1 The coronary arteries are then reimplanted to the graft with a side‐to‐end type anastomosis. It is the treatment of choice for patients with annuloaortic dilatation, aortic dissection and aortic root and valve disorders.
To prevent traction‐related haemorrhage and pseudoaneurysm formation, the Cabrol technique2 is utilized for coronary reimplantation where a second smaller Dacron tube is interposed between the coronary ostia and anastomosed side‐to‐side to the composite valve conduit.2 A fistula from the perigraft space to right atrium is also formed to facilitate drainage of haemoserous fluid.2
Kinking of the interposition graft, occlusion of the coronary ostia and graft thrombosis have been reported with the Cabrol technique.3 This can lead to sudden cardiac death and global myocardial infarction. Bypass surgery or PCI are reported as viable revascularization options.4
An 83‐year‐old man presented with worsening exertional angina. Previous history included St Jude aortic valve replacement in 1991 complicated by ascending aortic dissection requiring a Bentall's repair with a Cabrol procedure. Coronary angiography (Fig. 1) revealed a 90% stenosis at the anastomosis site of the Dacron graft and left main stem. Unfortunately, he suffered a fatal cardiac arrest while awaiting surgical revascularization (Video S1).
This case highlights the importance of urgent revascularization of severe stenosis when encountered as a complication of the Cabrol procedure.
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