J S Coselli1, C Köksoy, S A LeMaire. 1. Department of Surgery, Baylor College of Medicine, The Methodist Hospital, Houston, Texas, USA. jcoselli@bcm.tmc.edu
Abstract
BACKGROUND: We reviewed our experience managing patients with thoracic aortic graft infections to evaluate their clinical characteristics and outcomes of treatment. METHODS: Records of 20 consecutive patients with thoracic aortic graft infections managed over a 7 year period were retrospectively reviewed. Current follow-up status was obtained for all survivors. RESULTS; Nineteen patients (95%) underwent surgical treatment. Graft excision and in situ replacement were performed using Dacron grafts (10/19, 53%) or cryopreserved homografts (5/19, 26%). Three pseudoaneurysms were managed by debridement and primary repair. Although 30 day postoperative survival was 89% (17/19), in-hospital mortality occurred in 8 patients (42%). Infected thoracoabdominal aortic grafts were universally fatal. Of 6 patients with infected composite valve grafts, both patients who received new composite valve grafts died and all 4 who received homografts survived (p = 0.067). CONCLUSIONS: Infections involving thoracic aortic grafts continue to carry a high mortality rate, especially in patients with polymicrobial infections, thoracoabdominal aortic graft infections, and composite valve graft infections. Use of homografts in the latter situation may improve outcome.
BACKGROUND: We reviewed our experience managing patients with thoracic aortic graft infections to evaluate their clinical characteristics and outcomes of treatment. METHODS: Records of 20 consecutive patients with thoracic aortic graft infections managed over a 7 year period were retrospectively reviewed. Current follow-up status was obtained for all survivors. RESULTS; Nineteen patients (95%) underwent surgical treatment. Graft excision and in situ replacement were performed using Dacron grafts (10/19, 53%) or cryopreserved homografts (5/19, 26%). Three pseudoaneurysms were managed by debridement and primary repair. Although 30 day postoperative survival was 89% (17/19), in-hospital mortality occurred in 8 patients (42%). Infected thoracoabdominal aortic grafts were universally fatal. Of 6 patients with infected composite valve grafts, both patients who received new composite valve grafts died and all 4 who received homografts survived (p = 0.067). CONCLUSIONS: Infections involving thoracic aortic grafts continue to carry a high mortality rate, especially in patients with polymicrobial infections, thoracoabdominal aortic graft infections, and composite valve graft infections. Use of homografts in the latter situation may improve outcome.
Authors: Megan D Henley; Mark A Farber; John S Ikonomidis; Lavinia M Kolarczyk; Emily G Teeter; Brian P Barrick; Thomas G Caranasos; Susan M Martinelli Journal: J Cardiothorac Vasc Anesth Date: 2017-08-26 Impact factor: 2.628
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