Utilization of the Cabrol shunt in aortic surgery-from the ‘wrap technique’ to veno-arterial extracorporeal membrane oxygenation setting : A narrative review

The Cabrol shunt has been broadly used to control postoperative heamorrhage in aortic surgery since its first description in 1981. The initial description and its modifications aim to divert the blood from within the aneurysm wrap and/or the periaortic space to the venous system. We describe a modification in the context of central veno-arterial extracorporeal membrane oxygenation (VA-ECMO) after complex aortic surgery. A query on the PubMed was carried out using such keywords as ‘Cabrol shunt’, ‘Cabrol fistula’, ‘Aorta-atrial shunt’, ‘Perigraft shunt’, ‘Periaortic baffle’, and ‘Left-to-right shunts’. Original articles and case reports in which patients had undergone a Cabrol shunt or a modification to divert aortic bleeding to the venous circulation in the context of aortic surgery were included in the study. All publications were limited to the English language. On the other hand, abstracts and conference presentations, editorials, and correspondence comments were excluded. Finally, 18 articles and case reports were retrieved. A total of 392 cases of Cabrol shunt or a modification have been reported since 1987 with successful control of postoperative bleeding. Long-term results, when available, prove that the addition of a Cabrol shunt does not negatively affect mortality or postoperative complications, rather it decreases re-operation rates, blood transfusion, and hospital stay. Furthermore, the patency of the shunts beyond the immediate postoperative period has been described. The use of a modified Cabrol shunt in the setting of complex aortic surgery can effectively control peri-operative bleeding. Moreover, its application in other complex settings, such as central VA-ECMO, seems satisfactory.