Modified Cabrol Technique for Aortic Valve Re-Replacement in a Patient with Severe Prosthesis-Patient Mismatch and Small Aortic Root: A Case Report and Technical Innovation

Background:Prosthesis-patient mismatch (PPM) poses significant challenges in aortic valve re-replacement, particularly in patients with a small aortic root. Traditional annular enlargement techniques may be suboptimal in redo surgeries due to anatomical constraints and procedural risks. This case highlights a modified Cabrol technique to address severe PPM and redo vascular surgery. Case presentation: A 65-year-old female with a 19-mm mechanical aortic valve implanted 15 years prior presented with progressive exertional dyspnea (NYHA III) due to recurrent aortic stenosis.Transesophageal echocardiography confirmed severe stenosis (mean gradient 55 mmHg) secondary to pannus overgrowth. Computed tomography revealed a hypoplastic aortic root (22 mm).A modified Cabrol procedure was performed, involving aortic root reconstruction with a 24-mm Dacron graft, implantation of a 23-mm Edwards Perimount Magna bioprosthesis within a 26-mm graft, and coronary reimplantation using 8-mm Dacron conduits. Postoperative echocardiography demonstrated a mean transvalvular gradient of 12 mmHg. The patient recovered uneventfully, with sustained symptom relief and normal valve function at 1-year follow-up. Conclusions: This technique offers a safe and effective solution for redo aortic valve replacement in small aortic roots, minimizing PPM while preserving coronary perfusion.