OBJECTIVES: Management of infected prosthetic aortic grafts in the ascending and or root is complex and multifaceted. We report our diagnostic pathway, management and outcomes, identifying successful strategies. METHODS: This was a retrospective, single center, observational study. Consecutive patients who underwent management of infected aortic grafts in the ascending and/or root at our institution between October 1998 and December 2019 were included. The main outcome measures were: discharge from hospital alive with at least 1 year survival, operative mortality and success of primary treatment strategy. RESULTS: Twenty-six patients presented with infection of proximal aortic grafts and were managed through a number of strategies with an overall hospital-survival of 81% and 1 year survival of 69%. Twenty of them ultimately underwent redo surgery with 25% operative mortality (within 24 h of surgery). Five patients underwent washout and irrigation of which two were successfully treated and cured with adjunctive antibiotics and two went on to have staged explant and definitive surgery. Interval between surgery and infection was 42.5 ± 35.8 months. All patients had at least one major criterion and three minor criterions with no diagnostic uncertainty. The commonest primary strategy was 3a (definitive surgery), (13/26, 50%). CONCLUSIONS: Adopting a systematic and flexible patient specific approach to the diagnosis and management of patients with proximal aortic graft infections results in reasonable overall 1 year survival. In the majority of patients surgery is ultimately required in an attempt to achieve a curative treatment; however this comes with high operative mortality risk.
OBJECTIVES: Management of infected prosthetic aortic grafts in the ascending and or root is complex and multifaceted. We report our diagnostic pathway, management and outcomes, identifying successful strategies. METHODS: This was a retrospective, single center, observational study. Consecutive patients who underwent management of infected aortic grafts in the ascending and/or root at our institution between October 1998 and December 2019 were included. The main outcome measures were: discharge from hospital alive with at least 1 year survival, operative mortality and success of primary treatment strategy. RESULTS: Twenty-six patients presented with infection of proximal aortic grafts and were managed through a number of strategies with an overall hospital-survival of 81% and 1 year survival of 69%. Twenty of them ultimately underwent redo surgery with 25% operative mortality (within 24 h of surgery). Five patients underwent washout and irrigation of which two were successfully treated and cured with adjunctive antibiotics and two went on to have staged explant and definitive surgery. Interval between surgery and infection was 42.5 ± 35.8 months. All patients had at least one major criterion and three minor criterions with no diagnostic uncertainty. The commonest primary strategy was 3a (definitive surgery), (13/26, 50%). CONCLUSIONS: Adopting a systematic and flexible patient specific approach to the diagnosis and management of patients with proximal aortic graft infections results in reasonable overall 1 year survival. In the majority of patients surgery is ultimately required in an attempt to achieve a curative treatment; however this comes with high operative mortality risk.
Authors: Nabil Chakfé; Holger Diener; Anne Lejay; Ojan Assadian; Xavier Berard; Jocelyne Caillon; Inge Fourneau; Andor W J M Glaudemans; Igor Koncar; Jes Lindholt; Germano Melissano; Ben R Saleem; Eric Senneville; Riemer H J A Slart; Zoltan Szeberin; Maarit Venermo; Frank Vermassen; Thomas R Wyss; Gert J de Borst; Frederico Bastos Gonçalves; Stavros K Kakkos; Philippe Kolh; Riikka Tulamo; Melina Vega de Ceniga; Regula S von Allmen; Jos C van den Berg; E Sebastian Debus; Mark J W Koelemay; Jose P Linares-Palomino; Gregory L Moneta; Jean-Baptiste Ricco; Anders Wanhainen Journal: Eur J Vasc Endovasc Surg Date: 2020-02-05 Impact factor: 7.069
Authors: Julia Umminger; Heike Krueger; Erik Beckmann; Tim Kaufeld; Felix Fleissner; Axel Haverich; Malakh Shrestha; Andreas Martens Journal: Eur J Cardiothorac Surg Date: 2016-05-12 Impact factor: 4.191
Authors: Gilbert Habib; Patrizio Lancellotti; Manuel J Antunes; Maria Grazia Bongiorni; Jean-Paul Casalta; Francesco Del Zotti; Raluca Dulgheru; Gebrine El Khoury; Paola Anna Erba; Bernard Iung; Jose M Miro; Barbara J Mulder; Edyta Plonska-Gosciniak; Susanna Price; Jolien Roos-Hesselink; Ulrika Snygg-Martin; Franck Thuny; Pilar Tornos Mas; Isidre Vilacosta; Jose Luis Zamorano Journal: Eur Heart J Date: 2015-08-29 Impact factor: 29.983
Authors: Thomas M Joudinaud; Franck Baron; Richard Raffoul; Bruno Pagis; Mathieu Vergnat; Caroline Parisot; Ulrik Hvass; Patrick R Nataf Journal: Eur J Cardiothorac Surg Date: 2008-03-06 Impact factor: 4.191
Authors: Guglielmo Saitto; Marco Russo; Marta Pugliese; Sara R Vacirca; Fabio Bertoldo; Paolo Nardi; Giovanni Ruvolo Journal: Aorta (Stamford) Date: 2019-10-15
Authors: Ashley T Giammarino; Iam Claire Sarmiento; SJacob Scheinerman; John Winalski; Richard S Lazzaro; Derek R Brinster; Jonathan M Hemli Journal: J Med Case Rep Date: 2022-05-10
Authors: Amer Harky; Ahmed Othman; Carlos Nistal De Paz; Matthew Shaw; Omar Nawaytou; Deborah Harrington; Manoj Kuduvalli; Mark Field Journal: J Card Surg Date: 2020-11-10 Impact factor: 1.620
Authors: Martina Sollini; Francesco Bartoli; Roberto Boni; Roberta Zanca; Andrea Colli; Maurizio Levantino; Francesco Menichetti; Mauro Ferrari; Raffaella Berchiolli; Elena Lazzeri; Paola A Erba Journal: Front Cardiovasc Med Date: 2021-12-01