Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study.

Heinola, Ivika; Sörelius, Karl; Wyss, Thomas; Eldrup, Nikolaj; Settembre, Nicla; Setacci, Carlo; Mani, Kevin; Kantonen, Ilkka; Venermo, Maarit (2018). Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study. Journal of the American Heart Association, 7(12) American Heart Association 10.1161/JAHA.117.008104

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BACKGROUND

The treatment of mycotic abdominal aortic aneurysm requires surgery and antimicrobial therapy. Since prosthetic reconstructions carry a considerable risk of reinfection, biological grafts are noteworthy alternatives. The current study evaluated the durability, infection resistance, and midterm outcome of biological grafts in treatment of mycotic abdominal aortic aneurysm.

METHODS AND RESULTS

All patients treated with biological graft in 6 countries between 2006 and 2016 were included. Primary outcome measures were 30- and 90-day survival, treatment-related mortality, and reinfection rate. Secondary outcome measures were overall mortality and graft patency. Fifty-six patients (46 males) with median age of 69 years (range 35-85) were included. Sixteen patients were immunocompromised (29%), 24 (43%) had concomitant infection, and 12 (21%) presented with rupture. Bacterial culture was isolated from 43 (77%). In-situ aortic reconstruction was performed using autologous femoral veins in 30 patients (54%), xenopericardial tube-grafts in 12 (21%), cryopreserved arterial/venous allografts in 9 (16%), and fresh arterial allografts in 5 (9%) patients. During a median follow-up of 26 months (range 3 weeks-172 months) there were no reinfections and only 3 patients (5%) required assistance with graft patency. Thirty-day survival was 95% (n=53) and 90-day survival was 91% (n=51). Treatment-related mortality was 9% (n=5). Kaplan-Meier estimation of survival at 1 year was 83% (95% confidence interval, 73%-94%) and at 5 years was 71% (52%-89%).

CONCLUSIONS

Mycotic abdominal aortic aneurysm repair with biological grafts is a durable option for patients fit for surgery presenting an excellent infection resistance and good overall survival.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Wyss, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2047-9980

Publisher:

American Heart Association

Language:

English

Submitter:

Daniela Huber

Date Deposited:

20 Jul 2018 12:43

Last Modified:

24 Oct 2019 19:48

Publisher DOI:

10.1161/JAHA.117.008104

PubMed ID:

29886419

Uncontrolled Keywords:

allograft aneurysm aorta autologous vein femoral vein graft infection in situ reconstruction vein

BORIS DOI:

10.7892/boris.118851

URI:

https://boris.unibe.ch/id/eprint/118851

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