Midterm Outcomes of Neo-Modified Cabrol Coronary Reconstruction in Root-Involved Type A Aortic Dissection: A Single-Center Cohort Study.

Abstract

In Stanford type A aortic dissection with root involvement, coronary reconstruction determines perioperative safety and long-term perfusion. Outcomes of neo-modified Cabrol were evaluated in root-involved type A aortic dissection, with original Bentall serving as a contemporary reference. A retrospective single-center cohort (December 2012-June 2023) of 398 consecutive patients (neo-modified Cabrol, 349; original Bentall, 49) was analyzed. Baseline balance was improved by propensity scores with overlap weighting. The primary end point was 30-day all-cause mortality. Secondary end points included overall survival, computed tomography angiography-defined stenosis or occlusion of coronary interposition grafts, and major adverse valve-related events. Thirty-day mortality was 7.2% (25/349) with neo-modified Cabrol and 8.2% (4/49) with original Bentall. Major perioperative complications did not differ significantly. Reverse Kaplan-Meier median follow-up was 4.23 years (3.55-5.85 years) for neo-modified Cabrol and 11.48 years (7.55-11.48 years) for original Bentall. Survival at 1 year, 5 years, and 10 years was 89.4%, 85.7%, and 82.5% for neo-modified Cabrol and 87.8%, 81.2%, and 73.7% for original Bentall. In a 30-day landmark overlap-weighted Cox model, late mortality hazard ratio was 0.69 (95% CI, 0.26-1.79); P = .442. Clinical follow-up of 30-day survivors was 100%. Graft-related events were rare (Gray P = .521); 2 cases of anastomotic stenosis occurred in the neo-modified Cabrol group, 1 moderate right coronary ostial and 1 severe left coronary ostial. Neo-modified Cabrol showed favorable perioperative and midterm outcomes in type A aortic dissection with root involvement.