Self Made Xeno-pericardial Aortic Tubes to Treat Native and Aortic Graft Infections.

Weiss, Salome; Tobler, Eva-Luca; von Tengg-Kobligk, Hendrik; Makaloski, Vladimir; Becker, Daniel; Carrel, Thierry; Schmidli, Jürg; Wyss, Thomas (2017). Self Made Xeno-pericardial Aortic Tubes to Treat Native and Aortic Graft Infections. European journal of vascular and endovascular surgery EJVES, 54(5), pp. 646-652. Elsevier 10.1016/j.ejvs.2017.07.017

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OBJECTIVES

The most appropriate material for reconstruction of the aorta for native or graft infection remains a matter for debate. This study examines the mid-term outcome of patients and graft durability after in situ aortic reconstruction with self made bovine pericardial tube grafts.

METHODS

This was a retrospective analysis of all patients who underwent in situ aortic reconstruction using self made bovine pericardial tube grafts between January 2008 and December 2015 at a tertiary referral centre. Peri-operative and mid-term outcomes including mortality and re-infection were analysed at the end of January 2017. Available follow-up imaging was reviewed to assess graft durability.

RESULTS

Bovine pericardial aortic tube grafts were used in 35 patients (86% male) with a median age of 69 years (range 38-84) to reconstruct the ascending aorta or the aortic arch (7), the descending (7), the thoraco-abdominal (7), or the abdominal (14) aorta. Twelve patients (34%) were treated for infection of the native aorta and 23 (66%) for prosthetic graft infection. Twenty-two patients (63%) underwent emergency surgery. Thirty day mortality was 31% (n = 11). Additionally, six patients died during follow-up after a median of 33 months (range 3-70). For the remaining patients, mean follow-up was 48 months (± 26) with a mean Follow-Up Index of 0.98 ± 0.08. There were no readmissions or re-operations for re-infection or graft related complications. Follow-up imaging showed no signs of graft degeneration after a median of 15 months (range 3-68).

CONCLUSIONS

Surgical treatment of native and aortic graft or endograft infection remains high risk. Self made bovine pericardial tube grafts for in situ reconstruction are a promising option offering many advantages. Despite high early mortality rates, early radiological and mid-term clinical results are good. Definitive eradication of the infection seems feasible after in situ insertion of xeno-pericardial material for aortic repair.

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