Long-term results with cryopreserved arterial allografts (CPAs) in the treatment of graft or primary arterial infections.
OBJECTIVE
Our purpose was to evaluate our results with CPAs in patients with infected grafts or primary arterial infection with emphasis on long-term durability of these grafts.


METHODS
To evaluate the long-term durability of CPAs, clinical outcomes were analyzed following their use for either graft or primary arterial infections at a single institution over a 9-y period (2000-2009). The 30-d mortality rate, 90-d mortality rate, and the cause of early mortality were determined in each case. Among those surviving 90 d, the grafts were evaluated for subsequent failure.


RESULTS
From 2000 through 2009, 51 patients with either infected prosthetic grafts (35) or primary arterial infections (15) received CPAs. One patient had infection of a previously placed thoracic allograft. Forty-three graft infections involved either the thoracic or abdominal aorta. Eleven patients presented with fulminant sepsis with systemic inflammatory response syndrome (SIRS), seven of whom died postoperatively. Eight patients presented with aorto-enteric, esophageal, or bronchial fistulae with infected prosthetic grafts. The 30-d mortality rate was 25.5% (11 deaths) seven of which occurred in patients with SIRS. The 90-d mortality rate was 41.4%. There were 10 graft failures, seven occurring in patients with aorto-enteric or bronchial fistulae all of whom had recurrent hemorrhage. The other three graft failures were due to anastomotic hemorrhage in the early postoperative period. Among those surviving 90 d, the mean follow-up was 46.4 mo (range 1-112 mo). No aneurysmal degeneration of the CPAs was noted. Only one subsequent allograft graft failure was noted among those surviving more than 90 d.


CONCLUSIONS
CPAs are a suitable option in dealing with cardiovascular infections. Patients with enteric or bronchial fistulae are a difficult group to treat perhaps because of ongoing contamination of the allograft. The operative mortalities are largely determined by patient comorbidities (SIRS). Subsequent degeneration or infection of the CPAs is rare.
Department of Cardiovascular Surgery, Clarian Health Partners, Inc., Methodist Hospital, Indianapolis, Indiana, USA. rmccgoirish@aol.com
Robert A
RA
McCready
M Ann
MA
Bryant
John W
JW
Fehrenbacher
Daniel J
DJ
Beckman
Arthur C
AC
Coffey
Joel S
JS
Corvera
David A
DA
Hormuth
Thomas C
TC
Wozniak
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000637:transplantation; D001013:Aorta, Thoracic / Q000637:transplantation; D002339:Carotid Arteries / Q000637:transplantation; D015925:Cryopreservation; D005260:Female; D005263:Femoral Artery / Q000637:transplantation; D005402:Fistula / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D006084:Graft Rejection / Q000382:microbiology* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D018805:Sepsis / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000382:microbiology* / Q000401:mortality / Q000601:surgery*; D058017:Vascular Grafting / Q000009:adverse effects / Q000379:methods*