Cabrol Procedure and Its Modifications： A Systematic Review and Meta-Analysis

Abstract

Abstract Background Cabrol procedure has undergone various modifications and advancements since it was invented. However, there is a notable gap in the literature regarding meta-analyses assessing the Cabrol procedure. Methods A systematic review and meta-analysis were conducted to evaluate the effectiveness and long-term outcomes of the Cabrol procedure and its modifications. Pooling was conducted using random-effects model. Outcome events were reported as linearized occurrence rates (percentage per patient year) with 95% confidence intervals. Results A total of 14 studies involving 833 patients (mean age: 50 years; 71% male) were included in the meta-analysis. The pooled early mortality rate was 9.0% (66 patients), and the combined rate of reoperation due to bleeding was 4.9% (17 patients). During the average 4.4-year follow-up (3,727 patient-years), the annual occurrence rates (linearized) for complications were as follows: 3.63% (2.79–4.73) for late mortality, 0.64% (0.35–1.18) for aortic root reoperation, 0.57% (0.25–1.31) for hemorrhage events, 0.66% (0.16–2.74) for thromboembolism, 0.60% (0.29–1.26) for endocarditis, 2.32% (1.04–5.16) for major valve-related adverse events, and 0.58% (0.34–0.98) for Cabrol-related coronary graft complications. Conclusion This systematic review provides evidence that the outcomes of the Cabrol procedure and its modifications are acceptable in terms of mortality, reoperation, anticoagulation, valve-related complications, especially in Cabrol-related coronary graft complications. Notably, the majority of Cabrol procedures were performed in reoperation and complex cases. Furthermore, the design and anastomosis of the dacron interposition graft for coronary reimplantation, considering natural anatomy and physiological hemodynamics, may represent a promising avenue for future advancements in this field.