European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2024
Mid-term results of a case series on branched xenopericardial roll graft replacement to treat aortic arch/arch graft infection.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Kubota Hiroshi, Endo Hidehito, Minegishi Sachito, Tsuchiya Hiroshi, Inaba Yusuke, Takahashi Yu, Shimasaki Teppei, Kurai Daisuke, Nakazawa Harumasa, Ohura Norihiko
Аннотация
OBJECTIVES: We conducted this case series to evaluate the feasibility and mid-term outcomes of orthotopic aortic arch reconstruction using xenopericardial grafts to treat native aortic arch/arch graft infection.
METHODS: Between 2010 and 2023, adopting a multidisciplinary approach, we treated consecutive patients with aortic arch/arch graft infection by orthotopic branched xenopericardial roll graft replacement and tissue filling. The end points of the study were the graft reinfection and graft-related complications such as pseudoaneurysm formation, thromboembolism, graft stenosis, graft calcification and death.
RESULTS: The subjects were 11 patients (8 men and 3 women) with a median age of 66 [51-79, (interquartile range) 59.0, 70.5] years. Of the 11 patients, 7 underwent preoperative mediastinal irrigation/negative-pressure wound treatment. The 30-day mortality was 0% (0/11 patients), and 1 patient died in the hospital after 8 months. Aorta-related death occurred in 18.2% (2/11 patients), with both cases developing local recurrence of fungal infection. The remaining 9 patients (81.8%) remained free of reinfection. The estimated 1-, 3-, 5- and 7-year risk-adjusted survival rates were 91 ± 9%, 81 ± 12%, 58 ± 16% and 58 ± 16%, respectively. The estimated 1-, 3-, 5- and 7-year cumulative aorta-related mortality rates were 9 ± 9%, 19 ± 12%, 19 ± 12% and 19 ± 12%, respectively. Graft-related complications included branch kinking in 1 patient and graft rupture in 1 patient. There were no cases of graft-related thromboembolism or graft calcification. The median follow-up period was 45 [8-101, (interquartile range) 36.5, 70.9] months. The longest follow-up period until date of the currently surviving patients is 101 months.
CONCLUSIONS: Although the xenopericardium appeared to be vulnerable to fungal infection, based on the favourable results obtained, we consider that branched xenopericardial roll graft replacement using a multidisciplinary, staged approach may serve as a useful treatment option for aortic arch/arch graft infection.
METHODS: Between 2010 and 2023, adopting a multidisciplinary approach, we treated consecutive patients with aortic arch/arch graft infection by orthotopic branched xenopericardial roll graft replacement and tissue filling. The end points of the study were the graft reinfection and graft-related complications such as pseudoaneurysm formation, thromboembolism, graft stenosis, graft calcification and death.
RESULTS: The subjects were 11 patients (8 men and 3 women) with a median age of 66 [51-79, (interquartile range) 59.0, 70.5] years. Of the 11 patients, 7 underwent preoperative mediastinal irrigation/negative-pressure wound treatment. The 30-day mortality was 0% (0/11 patients), and 1 patient died in the hospital after 8 months. Aorta-related death occurred in 18.2% (2/11 patients), with both cases developing local recurrence of fungal infection. The remaining 9 patients (81.8%) remained free of reinfection. The estimated 1-, 3-, 5- and 7-year risk-adjusted survival rates were 91 ± 9%, 81 ± 12%, 58 ± 16% and 58 ± 16%, respectively. The estimated 1-, 3-, 5- and 7-year cumulative aorta-related mortality rates were 9 ± 9%, 19 ± 12%, 19 ± 12% and 19 ± 12%, respectively. Graft-related complications included branch kinking in 1 patient and graft rupture in 1 patient. There were no cases of graft-related thromboembolism or graft calcification. The median follow-up period was 45 [8-101, (interquartile range) 36.5, 70.9] months. The longest follow-up period until date of the currently surviving patients is 101 months.
CONCLUSIONS: Although the xenopericardium appeared to be vulnerable to fungal infection, based on the favourable results obtained, we consider that branched xenopericardial roll graft replacement using a multidisciplinary, staged approach may serve as a useful treatment option for aortic arch/arch graft infection.