A large vegetation on a xenopericardial roll elephant trunk graft

Minegishi, Sachito; Inaba, Yusuke; Endo, Hidehito; Kubota, Hiroshi

doi:10.1016/j.xjtc.2020.12.001

JTCVS Techniques

2021

DOI: 10.1016/j.xjtc.2020.12.001

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A large vegetation on a xenopericardial roll elephant trunk graft

Sachito Minegishi

Yusuke Inaba

Hidehito Endo

et al.

Abstract: Video clip is available online.Elephant trunk (ET) graft infection is a rare complication. 1 We present the uncommon case of a large vegetation on an ET, which almost totally occluded the lumen during the late postoperative period.

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“…In this edition of the Journal , Minegishi and colleagues 1 present a patient who underwent total arch replacement with elephant trunk for type A dissection. She developed an Enterobacter cloacae graft infection and underwent redo total arch replacement with xenopericardial roll graft.…”

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confidence: 99%

Commentary: Recurrent xenopericardial elephant trunk graft infection: Snatching victory from the jaws of defeat

et al. 2021

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mentioning

confidence: 99%

Commentary: Recurrent xenopericardial elephant trunk graft infection: Snatching victory from the jaws of defeat

et al. 2021

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“…Minegishi and colleagues 3 describe an interesting case of a 72-year-old-woman with an ATAAD undergoing emergency total aortic arch replacement with FET complicated by recurrent early bacterial and eventually fungal prosthetic graft infection involving the repeatedly replaced xenopericardial roll elephant trunk. The authors should be congratulated for their Herculean management of the impossibly difficult problem of recurrent prosthetic graft infection.…”

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confidence: 99%

Commentary: The elephant in the room: Routine arch repair for acute dissection?

et al. 2021

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Mid-term results of a case series on branched xenopericardial roll graft replacement to treat aortic arch/arch graft infection

Kubota,

Endo,

Minegishi

et al. 2024

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES We conducted this case series to evaluate the feasibility and mid-term outcomes of orthotopic aortic arch reconstruction using xenopericardial grafts to treat native aortic arch/arch graft infection. METHODS Between 2010 and 2023, adopting a multidisciplinary approach, we treated consecutive patients with aortic arch/arch graft infection by orthotopic branched xenopericardial roll graft replacement and tissue filling. The end-points of the study were the graft re-infection, graft-related complications such as pseudoaneurysm formation, thromboembolism, graft stenosis, graft calcification, and death. RESULTS The subjects were 11 patients (8 men and 3 women) with a median age of 66 (51 to 79, [IQR] 59.0, 70.5) years. Of the 11 patients, 7 underwent preoperative mediastinal irrigation/negative-pressure wound treatment. The 30-day mortality was 0% (0/11 patients), and one patient died in hospital, after 8 months. Aorta-related death occurred in 18.2% (2/11 patients), with both cases developing local recurrence of fungal infection. The remaining 9 patients (81.8%) remained free of re-infection. The estimated 1-, 3-, 5-, and 7-year risk-adjusted survival rates were 91 ± 9%, 81 ± 12%, 58 ± 16%, and 58 ± 16%, respectively. The estimated 1-, 3-, 5-, and 7-year cumulative aorta-related mortality rates were 9 ± 9%, 19 ± 12%, 19 ± 12%, and 19 ± 12%, respectively. Graft-related complications included branch kinking in 1 patient and graft rupture in 1 patient. There were no cases of graft-related thromboembolism or graft calcification. The median follow-up period was 45 (8 to101, [IQR] 36.5, 70.9) months.　The longest follow-up period until date of the currently surviving patients is 101 months. CONCLUSIONS Although the xenopericardium appeared to be vulnerable to fungal infection, based on the favorable results obtained, we consider that branched xenopericardial roll graft replacement using a multidisciplinary, staged approach may serve as a useful treatment option for aortic arch/arch graft infection.

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A large vegetation on a xenopericardial roll elephant trunk graft

Abstract: Video clip is available online.Elephant trunk (ET) graft infection is a rare complication. 1 We present the uncommon case of a large vegetation on an ET, which almost totally occluded the lumen during the late postoperative period.

Cited by 3 publications

References 8 publications

Commentary: Recurrent xenopericardial elephant trunk graft infection: Snatching victory from the jaws of defeat

Commentary: Recurrent xenopericardial elephant trunk graft infection: Snatching victory from the jaws of defeat

Commentary: The elephant in the room: Routine arch repair for acute dissection?

Mid-term results of a case series on branched xenopericardial roll graft replacement to treat aortic arch/arch graft infection

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