MODIFIED CABROL SHUNT AFTER COMPLEX REDO- AORTIC ROOT SURGERY
Dongsan Medical Center, Keimyung University, Daegu, Korea, Republic of.
OBJECTIVE: Bleeding after redo-aortic root replacement may be impossible to control in a certain situation.
Perigraft to right atrial shunt for hemorrhage control after aortic surgery was first described by Cabrol and colleagues. We report another modification of Cabrol shunt.
METHODS: 45 years old male patient with Behcet disease had history of aortic valve replacment with mechanical valve and transvenous permanent pacemaker implantation at 8 years ago and then he had replacced aortic root with aortic homograft due to severe aortic regurgitation and aortic prosthetic valve annular dehiscence at 7 years ago. He presented severe aortic regurgitation and severe homograft calcification due to aortic homograft failure(Fig 1). Patient was replaced with aortic root using button Bentall technique with St. Jude composite graft(St. Jude Medical, St. Paul, MN, USA). On-going bleeding from many operative sites occurred, including bleeding from aortic annular and both coronary button anastomosis sites due to aortic homograft calcificaiton. Bleeding continued despite of conventional maneuvers, including application of sutures, topical hemostatic agents, and recombinant factor VII. .As a result, a bovine pericardial patch( approximately 8 x 10cm) was tailored to isolate the area of bleeding from aortic root . Suturing the patch proceeded from the superior vena cava laterally on the patient’s right side along the right atrium inferiorly, and the border of the heart and pulmonary artery on the patient’s left side. After aortic root exclusion with bovine pericardial aptch, bovine patch was bulging due to bleeding and hypotension were noticed, so we decided to connect the cavity covered by bovine pericaridial patch to superior vena caval cannualtions sites using Goretex tube graft 6mm(Fig. 2).
RESULTS: Bleeding was controlled, as blood from aortic root suture line and adjacent tissue was redirected to superior vena cava creating autotransfusion of shed bloods as described originally by Cabrol and coleagues
Modified Cabrol shunt allows an option for dealing with severe bleeding in redo complex aortic root surgery
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