Xenopericardial roll graft replacement for infectious pseudoaneurysms and graft infections of the aorta

Abstract

BackgroundWhich graft material is the optimal graft material for the treatment of infected aortic aneurysms and aortic graft infections is still a matter of controversy. Orthotopic aortic reconstruction with intraoperatively prepared xenopericardial roll grafts without omentopexy was performed as the “initial” operation to treat aortic infection or as a “rescue” operation to treat graft infection. Mid-term outcomes were evaluated.MethodsBetween 2009 and 2013, orthotopic xenopericardial roll graft replacement was performed to treat eight patients (male/female: 6/2; mean age: 69.5 [55–80] yr). Graft material: equine/bovine pericardium: 2/6; type of operation: initial 4/rescue 4; omentopexy 0. Additional operation: esophagectomy 2. Mean follow-up period: 2.6 ± 1.6 (1.1–5.1) years.ResultsReplacement: ascending 3, arch 1 (reconstruction of neck vessels with small xenopericardial roll grafts), descending 3, and thoracoabdominal 1. Pathogens: MRSA 2, MSSA 1, Candida 1, E. coli 1, oral bacillus 1, and culture negative 2. Postoperative local recurrence of infection: 0. Graft-related complications: stenosis 0, calcification 0, non-infectious pseudoaneurysm of anastomosis 2 (surgical repair: 1/TEVAR 1). In-hospital mortality: 2 (MOF: initial 1/rescue 1); Survival rate exclusive of in-hospital deaths (~3 y): 100 %, but one patient died of lung cancer (3.6 yr).ConclusionsBecause xenopericardial roll grafts are not composed of synthetic material, the replacement procedure is simpler and less invasive than the standard procedure. Based on the favorable results obtained, this procedure may have the possibility to serve as an option for the treatment of aortic infections and aortic graft infections not only as a “rescue” treatment but as an “initial” treatment as well.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-015-0343-5) contains supplementary material, which is available to authorized users.

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

“…Made of bovine, porcine, or equine pericardium, they are easy to handle, readily available, and additionally are resistant to several endospores, microorganisms, and viruses, because of glutaraldehyde solution 29. Earlier reports on self‐made xenopericardial tubes have been encouraging with no graft‐related late mortality or reinfections 23, 24, 30. The present study yielded correlating results, but the considerably small number of patients in all of them calls for further investigations.…”

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

“…Xenopericardial material (self-made tube grafts) due to permanent off-the-shelf availability, ease of handling and good clinical results is favoured. 236,237 In addition, antibiotic therapy may be withdrawn in many cases during follow-up, which is the exception in patients after alloplastic replacement.…”

Branched xenopericardial roll graft replacement of an infected aortic arch graft

“…Although cryopreserved arterial homografts are one of the types of materials used to treat infected aortas, the supply in Japan is inadequate, and it is difficult to obtain one in time for an urgent operation. We previously reported eight cases of xenopericardial roll graft replacement to treat aortic/graft infection), and here we have reported the 9th case.…”