Treatment of infected hybrid arch prosthesis with self-assembled bovine elephant trunk grafts.

Reineke, David; Makaloski, Vladimir; Schoenhoff, Florian; Siepe, Matthias (2023). Treatment of infected hybrid arch prosthesis with self-assembled bovine elephant trunk grafts. European journal of cardio-thoracic surgery, 63(2) Oxford University Press 10.1093/ejcts/ezad025

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Graft infections are associated with severe morbidity and mortality. The widespread use of the frozen elephant technique (FET) increases the incidence of complex aortic patients to suffer from graft infections. Surgery of these patients is challenging. Removal of the stent graft portion of the FET prosthesis via sternotomy carries the risk of irreparable damage to the descending aorta. There is currently no single-stage surgical strategy that allows for removal of all infected material apart from a hemi-clamshell approach. This approach is technically demanding and associated with significant morbidity and mortality. This results in conservative treatment in a substantial number of patients. Pericardial tube grafts have shown to be an excellent option in treating graft infections in various aortic segments with promising results concerning freedom of re-infection and survival. We report a single-stage, trans-sternal approach to remove all infected material and simultaneous treat the descending aorta to prevent aortic catastrophe in two consecutive cases.

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