Studies in thoracic aortic graft infections: the development of a porcine model and a comparison of collagen-impregnated dacron grafts and cryopreserved allografts.
OBJECTIVE
A porcine model of thoracic aortic graft infection was created, and various anatomic sites and the timing of inoculation of the graft to induce infection were investigated. Ultimately, the ability of cryopreserved allograft to resist infection was compared with that of collagen-impregnated Dacron graft.


METHODS
Yorkshire pigs (n = 16) underwent placement of an expanded polytetrafluoroethylene patch graft in the ascending aorta and the left atrial appendage (phase I). Eight animals were immediately given a 50-mL bolus (1 x 10(8) cfu/mL) of Staphylococcus aureus whereas the other 8 received the infusion 24 hours later. Animals were put to death 8 weeks later and the grafts were sterilely explanted and analyzed via microbiologic culture and standard histologic procedures for evidence of infection. The results displayed that the aortic graft and a delay of induced bacteremia of 24 hours were more reliable methods of producing infection. During phase II, 13 pigs were randomized to receive either a collagen-impregnated Dacron graft (n = 6) or a cryopreserved allograft (n = 7) in the ascending aortic position only and infusion of S aureus 24 hours after the operation. The experiment then proceeded to completion.


RESULTS
Phase I results displayed that use of an aortic graft and induced bacteremia 24 hours after the operation was a more reliable and reproducible method of producing infection. In phase II, graft infection was present in 38.5% (5/13) of animals, with only 16.7% (1/6) in the collagen-impregnated Dacron graft group and 57.2% (4/7) in the cryopreserved allograft group becoming infected. There was no significant difference between the collagen-impregnated Dacron graft and cryopreserved allograft groups in the incidences of thoracic aortic graft infections (P =.27, Fisher exact test).


CONCLUSIONS
This novel porcine model of thoracic aortic graft infection is a reproducible method for the investigation of thoracic aortic graft infections. The phase I study investigated the timing of the induced bacteremia and the most susceptible position of a graft. Phase II demonstrated that collagen-impregnated Dacron grafts are equivalent, if not superior, to cryopreserved allografts in resisting central vascular graft infections in the ascending aorta.
Rowe
N M
NM
Department of Surgery, State University of New York, Health Science Center at Brooklyn, Brooklyn, NY 11203, USA.
Impellizzeri
P
P
Vaynblat
M
M
Lawson
N M
NM
Kim
Y D
YD
Sierra
M
M
Homel
P
P
Acinapura
A J
AJ
Cunningham
J N
JN
Burack
J H
JH
D000818:Animals; D001013:Aorta, Thoracic / Q000601:surgery; D016470:Bacteremia / Q000209:etiology; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D003094:Collagen; D015925:Cryopreservation; D011093:Polyethylene Terephthalates; D016459:Prosthesis-Related Infections / Q000209:etiology; D015203:Reproducibility of Results; D013203:Staphylococcal Infections / Q000209:etiology; D013552:Swine; D013997:Time Factors; D014184:Transplantation, Homologous
D011093:Polyethylene Terephthalates; D003094:Collagen