Surgical Treatment of Native and Prosthetic Aortic Infection With Xenopericardial Tube Grafts

Kreibich, Maximilian; Siepe, Matthias; Morlock, Julia; Beyersdorf, Friedhelm; Kondov, Stoyan; Scheumann, Johannes; Kari, Fabian A.; Berger, Tim; Schröfel, Holger; Rylski, Bartosz; Czerny, Martin

doi:10.1016/j.athoracsur.2018.03.012

Cited by 46 publications

(27 citation statements)

References 28 publications

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“…There were studies with small case numbers, which have reported the utilization of bovine pericardial grafts as a novel substitution of infected aorta. 26,27 This approach shows promising short-term results, but further studies are needed to evaluate the long-term solidarity of these grafts.…”

Section: Discussionmentioning

confidence: 99%

Infection-relapse and a potentially surgical stratification model for the treatment of mycotic aortic aneurysms: A propensity-matched pilot study

Liu

et al. 2019

Vascular

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Objective This study evaluates the overall survival and the infection-relapse after endovascular repair (Endo) vs. open surgery (Open) for mycotic aortic aneurysms and the potential influence of perioperative severity of infection to the decision-making on the long-term survival. Design A multicenter, retrospective analysis of 5247 consecutive aortic aneurysm repair performed from January 2003 to December 2017 at five tertiary medical centers was conducted. Among the study population, 257 patients with mycotic aortic aneurysms s were identified. Methods: Finally, 73 patients were enrolled in the cohort after exclusion and a 1:1 propensity-matched analysis. The study cohort drawn from matched data included 37 patients in the Endo group and 36 patients in the Open group. The primary endpoint was overall survival. Secondary endpoints included infection-relapse during the follow-up. Univariate and multivariate Cox regression analyses were used to assess predictors for late mortality. Results The mean follow-up time for the entire cohort was 41 months (range, 1 to 135 months). Among propensity-matched patients, there was no significant difference in baseline characteristics. There was no difference in overall survival ( P = 0.083) between the groups at five years, but Open group was associated with a lower infection-relapse incidence during the follow-up ( P = 0.011). Subgroup analysis revealed a better survival rate for Open in patients with severe infection ( P = 0.003) or small periaortic abscess ( P = 0.049). Conclusion There were no significant differences between Endo and Open in overall survival. However, Open was a more definite option with less infection-relapse and had potential advantages for patients with severe infection or with a small periaortic abscess.

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Section: Discussionmentioning

confidence: 99%

Infection-relapse and a potentially surgical stratification model for the treatment of mycotic aortic aneurysms: A propensity-matched pilot study

Liu

et al. 2019

Vascular

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“…39,40,44e46,48e50,52e 56,58,59,61,62,65,66,68,70,72,73,76,79e86,90,91,96e98,100,102e109,111,113e 118,120,121,124,127e129,131,132 Sixteen more studies were excluded because they described irrelevant topics other than abdominal AGI. 37,57,60,63,69,74,75,78,87,89,92,112,119,122,123,126 Finally, studies were excluded because of study design (n ¼ 5), 47,51,94,95,125 overlapping data (n ¼ 3), 42,43,99 language (n ¼ 9), 38,41,64,67,71,77,88,101,130 or a MINORS score < 9 (n ¼ 2). 93,110 A flow chart of the selection procedure is shown in Fig.…”

Section: Description Of Studiesmentioning

confidence: 99%

Systematic Review and Meta-Analysis on the Management of Open Abdominal Aortic Graft Infections

Post

Vos

2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS A systematic review of the literature was performed adhering to the PRISMA guidelines with strict selection criteria for study design, patient inclusion and exclusion criteria, and outcome reporting. This contributed to comparability of the individual study data. Since 2006 many new studies have been performed and these are included in the systematic review. Strict definitions and outcome criteria were used to improve comparability between the outcome data of the included studies. Objective: Aortic graft infection (AGI) is a disastrous complication with an incidence of 0.2e6% in operated patients. With little or no high quality evidence, the best treatment option remains unclear. Therefore, the literature on the management of open abdominal AGI was systematically reviewed to determine optimal treatment. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis was conducted for AGI. MEDLINE, Embase, and the Cochrane Database of Systematic Reviews were searched. Methodological quality was assessed using the Methodological Index for Non-randomised Studies (MINORS) score. Primary outcomes were 30 day mortality and one year survival. Secondary outcomes were survival, infection recurrence, limb salvage, and graft patency. Results: Of 1574 studies identified, 32 papers were included in the study. The overall quality of the studies was moderate, with an average MINORS score of 11.9. Pooled overall 30 day mortality and one year survival were 13.5% (95% CI 10.5e16.4) and 73.6% (95% CI 68.8e78.4), respectively. The lowest 30 day mortality and highest one year survival were found for in situ repair compared with extra-anatomic repair and for prosthetic grafts compared with venous grafts or arterial allografts. The infection recurrence rate was highest for prosthetic grafts. Conclusions: There is a lack of well designed, qualitative comparative studies making conclusive recommendations impossible. The current best available data suggests that partial graft removal should be avoided and the lowest 30 day mortality and best one year survival are achieved with in situ repair using prosthetic grafts. Initiatives such as the MAGIC database to collaboratively collect prospective data are an important step forward in obtaining more solid answers on this topic.

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“…Self-made tubes of bovine pericardium have been used to replace the ascending aorta and root with promising results. 51,52 When implanting a composite conduit in a fragile aortic annulus, the proximal anastomosis may be reinforced with pericardium. 53 Others have proposed variations of this technique still using pericardium to obtain a doughnut-shaped skirt of bovine pericardium to reinforce the aortic annulus.…”

Section: Valvular and Prosthetic Endocarditismentioning

confidence: 99%

“…Although this device may have definite indications, such as endocarditis or old patient age, nevertheless a word of caution has been raised due to high rate of reoperations warning against its use. 51,52 The use of valved conduits implies many suture lines with the potential for bleeding complications; the weakest points are at the coronary buttons anastomosis and pseudoaneurysm formation has been observed at this level in patients with fragile tissues such as those with dissection of Marfan's syndrome. 63 For such reason, some suggest the routine use of pericardial strips to reinforce these sutures.…”

Section: Surgery Of the Ascending Aortamentioning

confidence: 99%

Use of Pericardium for Cardiac Reconstruction Procedures in Acquired Heart Diseases—A Comprehensive Review

Martino¹,

Milano

Bortolotti³

2019

Thorac Cardiovasc Surg

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Background Reconstruction of cardiac structures has been the goal of many surgeons even before the advent of open-heart procedures with cardiopulmonary bypass. Unsatisfactory results with synthetic materials has switched the attention to biological tissues, among which pericardium, either autologous or of animal origin, has been widely used as patch material. Methods We have reviewed the literature to assess the effective role of pericardial tissue in the correction of various acquired cardiac lesions. Particularly, special attention was given not only to established techniques but also to detect any peculiar and unusual application of pericardium. Results Autologous pericardium is frequently used as patch material particularly when limited valvular lesions must be corrected, while xenograft pericardium appears particularly useful in patients with endocarditis and extensive destruction of the intracardiac structures by infection and abscesses. Pericardium is an extremely versatile material owing to its pliability and strength; however, it tends to calcify in the long term when in contact with blood, although stability of the repair is maintained in most cases. Conclusions Pericardium plays an important role in various cardiac and aortic pathologies. Tissues resistant to fibrosis and calcification to be used as patch material are the ideal solution for more successful cardiac reconstruction procedures and will hopefully be provided by the ongoing research.

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Surgical Treatment of Native and Prosthetic Aortic Infection With Xenopericardial Tube Grafts

Cited by 46 publications

References 28 publications

Infection-relapse and a potentially surgical stratification model for the treatment of mycotic aortic aneurysms: A propensity-matched pilot study

Infection-relapse and a potentially surgical stratification model for the treatment of mycotic aortic aneurysms: A propensity-matched pilot study

Systematic Review and Meta-Analysis on the Management of Open Abdominal Aortic Graft Infections

Use of Pericardium for Cardiac Reconstruction Procedures in Acquired Heart Diseases—A Comprehensive Review

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