Surgical treatment outcomes for thoracic aortic graft infections

P0323 

Abstract Submission 

Mathias Van Hemelrijck (1), Juri Sromicki (1), Petar Risteski (2), Michelle Frank (3), Bruno Ledergerber (4), Ronny R Buechel (5), Barbara Hasse (4), Hector Rodriguez Cetina Biefer (2), Omer Dzemali (2)

(1) Department of Cardiac Surgery, University Hospital Zurich, Zurich, NA, (2) Department of Cardiac Surgery, University Hospital and City Hospital Triemli, Zurich, NA, (3) Department of Cardiology, University Hospital Zurich, Zurich, NA, (4) Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, NA, (5) Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, NA

Mathias Van Hemelrijck    -  Contact Me
Department of Cardiac Surgery, University Hospital Zurich

Juri Sromicki    -  Contact Me
Department of Cardiac Surgery, University Hospital Zurich

Petar Risteski    -  Contact Me
Department of Cardiac Surgery, University Hospital and City Hospital Triemli

Michelle Frank    -  Contact Me
Department of Cardiology, University Hospital Zurich

Bruno Ledergerber    -  Contact Me
Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich

Ronny R Buechel    -  Contact Me
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich

Barbara Hasse    -  Contact Me
Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich

Hector Rodriguez Cetina Biefer    -  Contact Me
Department of Cardiac Surgery, University Hospital and City Hospital Triemli

Omer Dzemali    -  Contact Me
Department of Cardiac Surgery, University Hospital and City Hospital Triemli

Mathias Van Hemelrijck    -  Contact Me
Department of Cardiac Surgery, University Hospital Zurich

Objectives Aortic graft infections are associated with high mortality and antibiotic treatment and excisional surgery are paramount. The aim of the study was to assess characteristics and treatment outcomes of infected aortic root, ascending aorta, and aortic arch prosthetic grafts after reoperative surgery with thorough debridement. Methods Retrospective analysis of prospectively collected data from an ongoing cohort of patients with vascular graft infections. Patients who had am infected aortic root, ascending aorta or aortic arch prosthesis and were reoperated were included in this analysis. Patients treated with a conservative approach and those with infected prosthesis in other anatomical locations were excluded. Results From November 2012 until February 2023, 22 patients had root, ascending or aortic arch graft infection and underwent reoperations. Thereof, 95% (21/22) were male, median age was 62.5 years (Interquartile range: 55.6–72.7), and median BMI was 27.4 kg/m2 (24.9 – 29.9). Upon presentation, 32% (7/22) had dyspnea, 68% (15/22) reported on fever episodes and median LVEF was 54.5% (46.7 – 70). Median time from index surgery to diagnosis/re-operative surgery was 54.5 months (18–99.5) and 91% (20/22) were late infections. Past surgical history included operations for acute Type A aortic dissection in 40.9% (9/22) and aortic aneurysm in 54.5% (12/22); and 59% (13/22) were performed on an urgent/emergency setting. Polyester grafts were used in 91% (20/22) and 59% (13/22) received a Bentall-deBono procedure or a modified procedure with a biological prosthesis. Median EuroSCORE II at reoperation was 32% (16.2 – 48.3). Operative findings included cutaneous abscesses in 18% (4/22), mediastinal abscesses in 54% (12/22), and root abscesses in 45% (10/22). Duration of surgery was 450min (327.5 – 540), aortic-cross-clamping time 130min (112 – 199); and ECC-time 247min (174.5 – 310.5). The aortic valve or aortic valve prosthesis was involved in 73% (16/22). Re-operative techniques included in 63% (14/22) re-Bentall procedures; in 36% (8/22) a biological aortic prosthesis was used (homograft or xenopericardial tube). Operative mortality was 13% (3/22) and Staphylococci 36% (8/22) were the most common microorganisms. There were no patients lost to follow-up. At 4.3 years, 73% (CI 95%, 49 – 97) were survivors.
Conclusion Root, ascending and aortic arch prosthetic vascular graft infections are complex pathologies with high mortality rates if untreated. Re-operative surgery in combination with antimicrobial therapy remains the gold standard with good results at 4 years.

Other - Re-operation