Salome Weiss1, Eva-Luca Tobler1, Hendrik von Tengg-Kobligk2, Vladimir Makaloski1, Daniel Becker1, Thierry P Carrel1, Jürg Schmidli1, Thomas R Wyss3. 1. Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 2. Institute for Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 3. Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: thomas.wyss@insel.ch.
Abstract
OBJECTIVES: The most appropriate material for reconstruction of the aorta for native or graft infection remains a matter for debate. This study examines the mid-term outcome of patients and graft durability after in situ aortic reconstruction with self made bovine pericardial tube grafts. METHODS: This was a retrospective analysis of all patients who underwent in situ aortic reconstruction using self made bovine pericardial tube grafts between January 2008 and December 2015 at a tertiary referral centre. Peri-operative and mid-term outcomes including mortality and re-infection were analysed at the end of January 2017. Available follow-up imaging was reviewed to assess graft durability. RESULTS: Bovine pericardial aortic tube grafts were used in 35 patients (86% male) with a median age of 69 years (range 38-84) to reconstruct the ascending aorta or the aortic arch (7), the descending (7), the thoraco-abdominal (7), or the abdominal (14) aorta. Twelve patients (34%) were treated for infection of the native aorta and 23 (66%) for prosthetic graft infection. Twenty-two patients (63%) underwent emergency surgery. Thirty day mortality was 31% (n = 11). Additionally, six patients died during follow-up after a median of 33 months (range 3-70). For the remaining patients, mean follow-up was 48 months (± 26) with a mean Follow-Up Index of 0.98 ± 0.08. There were no readmissions or re-operations for re-infection or graft related complications. Follow-up imaging showed no signs of graft degeneration after a median of 15 months (range 3-68). CONCLUSIONS: Surgical treatment of native and aortic graft or endograft infection remains high risk. Self made bovine pericardial tube grafts for in situ reconstruction are a promising option offering many advantages. Despite high early mortality rates, early radiological and mid-term clinical results are good. Definitive eradication of the infection seems feasible after in situ insertion of xeno-pericardial material for aortic repair.
OBJECTIVES: The most appropriate material for reconstruction of the aorta for native or graft infection remains a matter for debate. This study examines the mid-term outcome of patients and graft durability after in situ aortic reconstruction with self made bovine pericardial tube grafts. METHODS: This was a retrospective analysis of all patients who underwent in situ aortic reconstruction using self made bovine pericardial tube grafts between January 2008 and December 2015 at a tertiary referral centre. Peri-operative and mid-term outcomes including mortality and re-infection were analysed at the end of January 2017. Available follow-up imaging was reviewed to assess graft durability. RESULTS:Bovine pericardial aortic tube grafts were used in 35 patients (86% male) with a median age of 69 years (range 38-84) to reconstruct the ascending aorta or the aortic arch (7), the descending (7), the thoraco-abdominal (7), or the abdominal (14) aorta. Twelve patients (34%) were treated for infection of the native aorta and 23 (66%) for prosthetic graft infection. Twenty-two patients (63%) underwent emergency surgery. Thirty day mortality was 31% (n = 11). Additionally, six patients died during follow-up after a median of 33 months (range 3-70). For the remaining patients, mean follow-up was 48 months (± 26) with a mean Follow-Up Index of 0.98 ± 0.08. There were no readmissions or re-operations for re-infection or graft related complications. Follow-up imaging showed no signs of graft degeneration after a median of 15 months (range 3-68). CONCLUSIONS: Surgical treatment of native and aortic graft or endograft infection remains high risk. Self made bovine pericardial tube grafts for in situ reconstruction are a promising option offering many advantages. Despite high early mortality rates, early radiological and mid-term clinical results are good. Definitive eradication of the infection seems feasible after in situ insertion of xeno-pericardial material for aortic repair.
Authors: Ivika Heinola; Karl Sörelius; Thomas R Wyss; Nikolaj Eldrup; Nicla Settembre; Carlo Setacci; Kevin Mani; Ilkka Kantonen; Maarit Venermo Journal: J Am Heart Assoc Date: 2018-06-09 Impact factor: 5.501
Authors: Paula R Keschenau; Alexander Gombert; Mohammed E Barbati; Houman Jalaie; Johannes Kalder; Michael J Jacobs; Drosos Kotelis Journal: J Thorac Dis Date: 2021-05 Impact factor: 2.895