title: Cryopreserved human allografts (homografts) for the management of graft infections in the ascending aortic position extending to the arch.
abstract: OBJECTIVE
  The management of infected Dacron grafts in the ascending aortic position involving the aortic arch and aortic root remains a technical challenge. Total replacement of the infected graft material with cryopreserved homografts appears to be an effective treatment strategy for these patients.
  
  
  METHODS
  Seventeen consecutive patients were operated on for infection of their ascending aortic graft where the aortic arch was also involved 26 ± 33 months after initial surgery, in 70%, for type A aortic dissection (12 acute aortic dissection type A and 1 chronic aortic dissection type A). The aortic root was additionally affected in 14 patients. Computed tomography and echocardiography follow-up was performed in all patients.
  
  
  RESULTS
  Hospital mortality was 24% (n = 4). Cardiopulmonary bypass and aortic cross-clamp times were 288 ± 128 and 165 ± 78 min, respectively. In 14 patients, the aortic root was replaced. Hypothermic circulatory arrest was necessary in all patients (41 ± 25 min) with additional cold selective antegrade cerebral perfusion in 14 (41 ± 30 min). During follow-up, 1 patient died due to a cerebral haemorrhage at 3 months and another at 4 years, of pulmonary embolism. Two patients were successfully reoperated on for degeneration of the aortic valve at 16 and 94 months; 1 patient had an early degeneration of the homograft and needed re-replacement with a homograft. In 2 other patients, a stent graft had to be placed to cover the distal anastomosis between the homograft and native aorta. In all others, recent follow-up revealed no degeneration of the implanted homografts.
  
  
  CONCLUSIONS
  Surgery for infected Dacron grafts in the ascending aortic position with involvement of the arch can be performed with an acceptable perioperative mortality. In case of degeneration of the valve, reoperations can be performed with good results in experienced hands. Therefore, we consider the concept of complete explantation of all infected material and replacement with homografts a successful treatment strategy. Nevertheless, close follow-up of the patients is mandatory so as not to miss any degeneration or reinfection of the implanted grafts.
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. nawid.khaladj@med.uni-muenchen.de
authors.forename: Nawid
authors.initials: N
authors.lastname: Khaladj
authors.forename: Ute
authors.initials: U
authors.lastname: Pichlmaier
authors.forename: Arne
authors.initials: A
authors.lastname: Stachmann
authors.forename: Sven
authors.initials: S
authors.lastname: Peterss
authors.forename: Angela
authors.initials: A
authors.lastname: Reichelt
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Maximilian
authors.initials: M
authors.lastname: Pichlmaier
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D001158:Arteries / Q000637:transplantation*; D001807:Blood Vessel Prosthesis / Q000382:microbiology*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D015925:Cryopreservation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D016459:Prosthesis-Related Infections / Q000097:blood / Q000601:surgery*; D014184:Transplantation, Homologous
chemical_list: D011093:Polyethylene Terephthalates
keywords: Aortic arch; Aortic dissection; Graft infection; Homograft