Mid-term results of a case series on branched xenopericardial roll graft replacement to treat aortic arch/arch graft infection.

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.