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

Autor:	Kubota H; Department of Cardiovascular Surgery, Kyorin University, Tokyo, Japan., Endo H; Department of Cardiovascular Surgery, Kyorin University, Tokyo, Japan., Minegishi S; Department of Cardiovascular Surgery, Kyorin University, Tokyo, Japan., Tsuchiya H; Department of Cardiovascular Surgery, Kyorin University, Tokyo, Japan., Inaba Y; Department of Cardiovascular Surgery, Kyorin University, Tokyo, Japan., Takahashi Y; Department of Cardiovascular Surgery, Kyorin University, Tokyo, Japan., Shimasaki T; Department of General Medicine, Kyorin University, Tokyo, Japan., Kurai D; Department of General Medicine, Kyorin University, Tokyo, Japan., Nakazawa H; Department of Anesthesia, Kyorin University, Tokyo, Japan., Ohura N; Department of Plastic and Reconstructive Surgery, Kyorin University, Tokyo, Japan.
Jazyk:	angličtina
Zdroj:	European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2024 Nov 04; Vol. 66 (5).
DOI:	10.1093/ejcts/ezae378
Abstrakt:	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 reinfection and 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 [51-79, (interquartile range) 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 1 patient died in the 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 reinfection. 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 [8-101, (interquartile range) 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 favourable 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. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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