Treatment of infectious aortic disease with bovine pericardial tube grafts

Abstract

OBJECTIVES Our aim was to evaluate the mid-term outcomes of bovine pericardial tube graft repair for infectious aortic disease in any aortic segment. METHODS Between May 2015 and July 2020, 45 patients were treated for infectious aortic disease of the native (n = 9) aorta or after (endo-)graft (n = 36) implantation with bovine pericardial tube grafts. Clinical, infectious details, outcomes and follow-up data were evaluated. RESULTS All aortic segments underwent pericardial tube graft or bifurcational replacement: the aortic root (n = 12, 27%), ascending aorta (n = 18, 40%), aortic arch (n = 7, 16%), descending aorta (n = 5, 11%), thoraco-abdominal aorta (n = 6, 13%) and abdominal aorta (n = 18, 40%) including the iliac arteries (n = 14, 31%). Organ fistulation (n = 15, 33%) was the most common underlying pathology. Seven patients (16%) expired in-hospital secondary to ongoing sepsis (n = 5, 11%), respiratory failure (n = 1, 2%) and unknown cause (n = 1, 2%). A fungal infection was predictive for in-hospital mortality (P = 0.026, odds ratio: 19.470). After a median follow-up of 11 [first quartile: 2, third quartile 26] months, 9 additional patients (20%) expired and 1 patient developed a postoperative spondylodiscitis at the level of the aortic tube graft. Hence, freedom from proven aortic graft re-infection was 98%. CONCLUSIONS Orthotopic aortic reconstruction using bovine pericardial tube grafts to treat infectious aortic disease is possible in any aortic segment. Organ fistulation is a frequently observed disease mechanism requiring concomitant treatment. Granted, the early attrition rate is substantial, but after the initial period, both survival and freedom from re-infection appear encouraging.

Early and Mid-Term Results of Native and Abdominal Aortic Graft Infection Treatment via Surgeon-Constructed Porcine Pericardial Aortic Tubes

“…Our group's 30 day mortality of 12.5% (n = 1) was also in line with 30-day mortality of 15.8% (n = 12/76) reported in 8 recent studies covering bovine pericardium tube grafts in abdominal aortic infection subgroup. [12][13][14][15][16][17][18][19] Once the patient survives the initial in-hospital period, promising survival and freedom from re-infection may be obtained in the midterm follow-up with our method. In patients without re-fistulation, there were no re-infections nor were secondary surgical procedures required.…”

“…The death occurred on the 21st postoperative day due to severe septicemia and multiorgan failure. The early postoperative course was uneventful in the remaining cases, and patients were discharged home after a median of 12 days (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

Surgical treatment of thoracic aortic pseudoaneurysm caused by Brucella melitensis

“…The bovine pericardial conduit was chosen instead of the artificial blood vessel, and biomaterials may have a better anti-infection ability. Maximilian Kreibich mentioned that orthotopic aortic reconstruction using bovine pericardial tube grafts to treat infectious aortic disease is possible in any aortic segment [ 4 ]. Brucella melitensis infection was confirmed by gene sequencing of postoperative pathological specimens.…”

Vascular graft infections

“…Several conduits are available for revascularization with differing advantages one each other: cryopreserved allografts represent the most biological solution with a low risk for re-infection (0%-7%) [58,[63][64][65][66] . Rifampicinbonded and silver-coated grafts have the lowest limb amputation rate of around 3% and are an excellent solution for emergency procedures, mainly in the abdominal and pelvic location [67] . Major drawbacks are the limited availability and graft-related complications from degeneration of cryopreserved allografts [58,64] and the relatively high rate of re-infection (> 10%) in rifampicin-bonded and silver-coated grafts.…”