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Abstract：
OBJECTIVE: Cabrol shunt has been introduced for surgical repair of type A aortic dissection (TAAD) without robust evidence supporting its routine preventive use.
METHODS: Adult patients with TAAD from China 5A study were included if surgically repaired between 2016 and 2022. Primary outcome was operative mortality according to Society of Thoracic Surgeons criterion. Overall, we compared clinical outcomes in patients with and without Cabrol shunt, and subgroup analysis were further examined between Cabrol shunt and outcome among patients with or without root replacement.
RESULTS: 3283 patients were finally identified for analysis, with median age of 51 (IQR 41-59) years, 2389 men, and 2201 treated with Cabrol shunt technique. Cabrol shunt-treated patients were more severely ill before surgery than those without Cabrol shunt. Overall, the rate of operative mortality was 6.6% (146/2201 in Cabrol shunt group and 71/1082 in non-Cabrol shunt group), with no association between Cabrol shunt and operative mortality (OR 1.012 (95% CI 0.754 to 1.357); p=0.938). Stratified by root replacement, Cabrol shunt was associated with similar risk of operative mortality either in patients without root replacement (OR 1.054 (0.747 to 1.487); p=0.764) or in patients with root replacement (OR 1.194 (0.563 to 2.536); p=0.644) (P interaction=0.765). Results were similar in multiple sensitivity analysis.
CONCLUSIONS: Cabrol shunt was not associated with either a greatly lowered or an increased risk of operative mortality, regardless of aortic root replacement. Our study did not support the use of Cabrol shunt as a routine preventive strategy in the treatment of TAAD.
BACKGROUND: NCT04398992.
METHODS: Adult patients with TAAD from China 5A study were included if surgically repaired between 2016 and 2022. Primary outcome was operative mortality according to Society of Thoracic Surgeons criterion. Overall, we compared clinical outcomes in patients with and without Cabrol shunt, and subgroup analysis were further examined between Cabrol shunt and outcome among patients with or without root replacement.
RESULTS: 3283 patients were finally identified for analysis, with median age of 51 (IQR 41-59) years, 2389 men, and 2201 treated with Cabrol shunt technique. Cabrol shunt-treated patients were more severely ill before surgery than those without Cabrol shunt. Overall, the rate of operative mortality was 6.6% (146/2201 in Cabrol shunt group and 71/1082 in non-Cabrol shunt group), with no association between Cabrol shunt and operative mortality (OR 1.012 (95% CI 0.754 to 1.357); p=0.938). Stratified by root replacement, Cabrol shunt was associated with similar risk of operative mortality either in patients without root replacement (OR 1.054 (0.747 to 1.487); p=0.764) or in patients with root replacement (OR 1.194 (0.563 to 2.536); p=0.644) (P interaction=0.765). Results were similar in multiple sensitivity analysis.
CONCLUSIONS: Cabrol shunt was not associated with either a greatly lowered or an increased risk of operative mortality, regardless of aortic root replacement. Our study did not support the use of Cabrol shunt as a routine preventive strategy in the treatment of TAAD.
BACKGROUND: NCT04398992.
摘要：
目的：Cabrol分流术已被用于A型主动脉夹层（TAAD）的外科修复，没有可靠的证据支持其常规的预防性使用。
方法：如果在2016年至2022年之间进行手术修复，则纳入来自中国5A研究的TAAD成年患者。主要结果是根据胸外科医师协会标准的手术死亡率。总的来说,我们比较了有和没有Cabrol分流的患者的临床结局，在有或没有进行牙根置换的患者中,进一步检查了Cabrol分流与结局之间的亚组分析.
结果：最终确定了3283名患者进行分析，平均年龄为51岁（IQR41-59岁），2389人,2201用Cabrol分流技术治疗。接受Cabrol分流治疗的患者在手术前比没有接受Cabrol分流治疗的患者病情严重。总的来说,手术死亡率为6.6%(Cabrol分流组146/2201,非Cabrol分流组71/1082),Cabrol分流术与手术死亡率之间无相关性（OR1.012（95％CI0.754至1.357）；p=0.938）。通过根替换分层，Cabrol分流术与无根部置换患者（OR1.054（0.747至1.487）；p=0.764）或有根部置换患者（OR1.194（0.563至2.536）；p=0.644）（P交互作用=0.765）的手术死亡率相似。多重敏感性分析结果相似。
结论：Cabrol分流术与手术死亡率大大降低或增加的风险无关。无论主动脉根部置换。我们的研究不支持使用Cabrol分流术作为TAAD治疗的常规预防策略。
背景：NCT04398992。
方法：如果在2016年至2022年之间进行手术修复，则纳入来自中国5A研究的TAAD成年患者。主要结果是根据胸外科医师协会标准的手术死亡率。总的来说,我们比较了有和没有Cabrol分流的患者的临床结局，在有或没有进行牙根置换的患者中,进一步检查了Cabrol分流与结局之间的亚组分析.
结果：最终确定了3283名患者进行分析，平均年龄为51岁（IQR41-59岁），2389人,2201用Cabrol分流技术治疗。接受Cabrol分流治疗的患者在手术前比没有接受Cabrol分流治疗的患者病情严重。总的来说,手术死亡率为6.6%(Cabrol分流组146/2201,非Cabrol分流组71/1082),Cabrol分流术与手术死亡率之间无相关性（OR1.012（95％CI0.754至1.357）；p=0.938）。通过根替换分层，Cabrol分流术与无根部置换患者（OR1.054（0.747至1.487）；p=0.764）或有根部置换患者（OR1.194（0.563至2.536）；p=0.644）（P交互作用=0.765）的手术死亡率相似。多重敏感性分析结果相似。
结论：Cabrol分流术与手术死亡率大大降低或增加的风险无关。无论主动脉根部置换。我们的研究不支持使用Cabrol分流术作为TAAD治疗的常规预防策略。
背景：NCT04398992。
