In situ reconstruction with cryopreserved arterial allografts: For management of mycotic aneurysms or aortic prosthetic graft infections: A multi-institutional experience

Wei Zhou, Peter H. Lin, Ruth L. Bush, Thomas T. Terramani, John H. Matsuura, Mitchell Cox, Eric Peden, Marlon A Guerrero, Eric J. Silberfein, Alan Dardik, David Rosenthal, Alan B. Lumsden

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Abstract

We designed this study to evaluate a multi-institutional experience regarding the efficacy of cryopreserved aortic allografts in the treatment of infected aortic prosthetic grafts or mycotic aneurysms. We reviewed clinical data of all patients from 4 institutions who underwent in situ aortic reconstruction with cryopreserved allografts for either infected aortic prosthetic graft or mycotic aneurysms from during a 6-year period. Relevant clinical variables and treatment outcomes were analyzed. A total of 42 patients (37 men; overall mean age 63 ± 13 years, range 41-74 years) were identified during this study period. Treatment indications included 34 primary aortic graft infections (81%), 6 mycotic aneurysms (22%), and 2 aortoenteric erosions (5%). Transabdominal and thoracoabdominal approaches were used in 38 (90%) and 4 patients (10%), respectively. Staphylococcus aureus was the most commonly identified organism (n=27, 64%). Although there was no intraoperative death, the 30-day operative mortality was 17% (n=7). There were 21 (50%) nonfatal complications, including local wound infection (n=8), lower-extremity deep venous thrombosis (n=5), amputation (n=6), and renal failure requiring hemodialysis (n=2). The average length of hospital stay was 16.4 ± 7 days. During a mean follow-up period of 12.5 months, reoperation for allograft revision was necessary in 1 patient due to graft thrombosis (6%). The overall treatment mortality rate was 21% (n=9). In situ aortic reconstruction with cryopreserved allografts is an acceptable treatment method in patients with infected aortic prosthetic graft or mycotic aneurysms. Our study showed that mid-term graft-related complications such as reinfection or aneurysmal degeneration were uncommon.

Original languageEnglish (US)
Pages (from-to)14-18
Number of pages5
JournalTexas Heart Institute Journal
Volume33
Issue number1
StatePublished - 2006
Externally publishedYes

Fingerprint

Infected Aneurysm
Allografts
Transplants
Infection
Length of Stay
Mortality
Wound Infection
Therapeutics
Reoperation
Amputation
Venous Thrombosis
Renal Insufficiency
Renal Dialysis
Staphylococcus aureus
Lower Extremity
Thrombosis

Keywords

  • Aneurysm, infected/surgery
  • Arteries/transplantation
  • Bacterial infections/complications/surgery
  • Blood vessel prosthesis/adverse effects
  • Cryopreservation
  • Prosthesis-related infections/surgery
  • Staphylococcal infections/surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

In situ reconstruction with cryopreserved arterial allografts : For management of mycotic aneurysms or aortic prosthetic graft infections: A multi-institutional experience. / Zhou, Wei; Lin, Peter H.; Bush, Ruth L.; Terramani, Thomas T.; Matsuura, John H.; Cox, Mitchell; Peden, Eric; Guerrero, Marlon A; Silberfein, Eric J.; Dardik, Alan; Rosenthal, David; Lumsden, Alan B.

In: Texas Heart Institute Journal, Vol. 33, No. 1, 2006, p. 14-18.

Research output: Contribution to journalArticle

Zhou, W, Lin, PH, Bush, RL, Terramani, TT, Matsuura, JH, Cox, M, Peden, E, Guerrero, MA, Silberfein, EJ, Dardik, A, Rosenthal, D & Lumsden, AB 2006, 'In situ reconstruction with cryopreserved arterial allografts: For management of mycotic aneurysms or aortic prosthetic graft infections: A multi-institutional experience', Texas Heart Institute Journal, vol. 33, no. 1, pp. 14-18.
Zhou, Wei ; Lin, Peter H. ; Bush, Ruth L. ; Terramani, Thomas T. ; Matsuura, John H. ; Cox, Mitchell ; Peden, Eric ; Guerrero, Marlon A ; Silberfein, Eric J. ; Dardik, Alan ; Rosenthal, David ; Lumsden, Alan B. / In situ reconstruction with cryopreserved arterial allografts : For management of mycotic aneurysms or aortic prosthetic graft infections: A multi-institutional experience. In: Texas Heart Institute Journal. 2006 ; Vol. 33, No. 1. pp. 14-18.
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abstract = "We designed this study to evaluate a multi-institutional experience regarding the efficacy of cryopreserved aortic allografts in the treatment of infected aortic prosthetic grafts or mycotic aneurysms. We reviewed clinical data of all patients from 4 institutions who underwent in situ aortic reconstruction with cryopreserved allografts for either infected aortic prosthetic graft or mycotic aneurysms from during a 6-year period. Relevant clinical variables and treatment outcomes were analyzed. A total of 42 patients (37 men; overall mean age 63 ± 13 years, range 41-74 years) were identified during this study period. Treatment indications included 34 primary aortic graft infections (81{\%}), 6 mycotic aneurysms (22{\%}), and 2 aortoenteric erosions (5{\%}). Transabdominal and thoracoabdominal approaches were used in 38 (90{\%}) and 4 patients (10{\%}), respectively. Staphylococcus aureus was the most commonly identified organism (n=27, 64{\%}). Although there was no intraoperative death, the 30-day operative mortality was 17{\%} (n=7). There were 21 (50{\%}) nonfatal complications, including local wound infection (n=8), lower-extremity deep venous thrombosis (n=5), amputation (n=6), and renal failure requiring hemodialysis (n=2). The average length of hospital stay was 16.4 ± 7 days. During a mean follow-up period of 12.5 months, reoperation for allograft revision was necessary in 1 patient due to graft thrombosis (6{\%}). The overall treatment mortality rate was 21{\%} (n=9). In situ aortic reconstruction with cryopreserved allografts is an acceptable treatment method in patients with infected aortic prosthetic graft or mycotic aneurysms. Our study showed that mid-term graft-related complications such as reinfection or aneurysmal degeneration were uncommon.",
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AB - We designed this study to evaluate a multi-institutional experience regarding the efficacy of cryopreserved aortic allografts in the treatment of infected aortic prosthetic grafts or mycotic aneurysms. We reviewed clinical data of all patients from 4 institutions who underwent in situ aortic reconstruction with cryopreserved allografts for either infected aortic prosthetic graft or mycotic aneurysms from during a 6-year period. Relevant clinical variables and treatment outcomes were analyzed. A total of 42 patients (37 men; overall mean age 63 ± 13 years, range 41-74 years) were identified during this study period. Treatment indications included 34 primary aortic graft infections (81%), 6 mycotic aneurysms (22%), and 2 aortoenteric erosions (5%). Transabdominal and thoracoabdominal approaches were used in 38 (90%) and 4 patients (10%), respectively. Staphylococcus aureus was the most commonly identified organism (n=27, 64%). Although there was no intraoperative death, the 30-day operative mortality was 17% (n=7). There were 21 (50%) nonfatal complications, including local wound infection (n=8), lower-extremity deep venous thrombosis (n=5), amputation (n=6), and renal failure requiring hemodialysis (n=2). The average length of hospital stay was 16.4 ± 7 days. During a mean follow-up period of 12.5 months, reoperation for allograft revision was necessary in 1 patient due to graft thrombosis (6%). The overall treatment mortality rate was 21% (n=9). In situ aortic reconstruction with cryopreserved allografts is an acceptable treatment method in patients with infected aortic prosthetic graft or mycotic aneurysms. Our study showed that mid-term graft-related complications such as reinfection or aneurysmal degeneration were uncommon.

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KW - Staphylococcal infections/surgery

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