Xenopericardial roll graft replacement for infectious pseudoaneurysms and graft infections of the aorta.
BACKGROUND
Which graft material is the optimal graft material for the treatment of infected aortic aneurysms and aortic graft infections is still a matter of controversy. Orthotopic aortic reconstruction with intraoperatively prepared xenopericardial roll grafts without omentopexy was performed as the "initial" operation to treat aortic infection or as a "rescue" operation to treat graft infection. Mid-term outcomes were evaluated.


METHODS
Between 2009 and 2013, orthotopic xenopericardial roll graft replacement was performed to treat eight patients (male/female: 6/2; mean age: 69.5 [55-80] yr). Graft material: equine/bovine pericardium: 2/6; type of operation: initial 4/rescue 4; omentopexy 0. Additional operation: esophagectomy 2. Mean follow-up period: 2.6 ± 1.6 (1.1-5.1) years.


RESULTS
Replacement: ascending 3, arch 1 (reconstruction of neck vessels with small xenopericardial roll grafts), descending 3, and thoracoabdominal 1. Pathogens: MRSA 2, MSSA 1, Candida 1, E. coli 1, oral bacillus 1, and culture negative 2. Postoperative local recurrence of infection: 0. Graft-related complications: stenosis 0, calcification 0, non-infectious pseudoaneurysm of anastomosis 2 (surgical repair: 1/TEVAR 1). In-hospital mortality: 2 (MOF: initial 1/rescue 1); Survival rate exclusive of in-hospital deaths (~3 y): 100 %, but one patient died of lung cancer (3.6 yr).


CONCLUSIONS
Because xenopericardial roll grafts are not composed of synthetic material, the replacement procedure is simpler and less invasive than the standard procedure. Based on the favorable results obtained, this procedure may have the possibility to serve as an option for the treatment of aortic infections and aortic graft infections not only as a "rescue" treatment but as an "initial" treatment as well.
Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan. kub@ks.kyorin-u.ac.jp.
Hiroshi
H
Kubota
Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Hidehito
H
Endo
Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Mio
M
Noma
Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Hikaru
H
Ishii
Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Hiroshi
H
Tsuchiya
Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Akihiro
A
Yoshimoto
Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Yu
Y
Takahashi
Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Yusuke
Y
Inaba
Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Yoshifumi
Y
Nishino
Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Masao
M
Nunokawa
Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Yutaka
Y
Hosoi
Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Tooru
T
Ikezoe
Department of Vascular Surgery, Tokyo University, Tokyo, Japan.
Masaru
M
Nemoto
Department of Vascular Surgery, Tokyo University, Tokyo, Japan.
Yoshihisa
Y
Makino
Department of Vascular Surgery, Tokyo University, Tokyo, Japan.
Yoko
Y
Nemoto
Department of Vascular Surgery, Tokyo University, Tokyo, Japan.
Mitsuru
M
Matsukura
Department of Gastroenterological Surgery, Kyorin University, Tokyo, Japan.
Masanori
M
Sugiyama
Department of Gastroenterological Surgery, Kyorin University, Tokyo, Japan.
Nobutsugu
N
Abe
Department of Gastroenterological Surgery, Kyorin University, Tokyo, Japan.
Hirohisa
H
Takeuchi
Department of Gastroenterological Surgery, Kyorin University, Tokyo, Japan.
Gen
G
Nagao
Department of Gastroenterological Surgery, Kyorin University, Tokyo, Japan.
Eri
E
Kondo
Kosei General Hospital affiliated to Rissho Kosei-Kai, Tokyo, Japan.
Osamu
O
Yanagida
Department of Cardiology, Kyorin University, Tokyo, Japan.
Hideaki
H
Yoshino
Jiseikai Nomura Hospital, Tokyo, Japan.
Kenichi
K
Sudo
D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000601:surgery*; D000818:Animals; D001011:Aorta / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D053821:Cardiovascular Infections / Q000601:surgery*; D002417:Cattle; D005260:Female; D064593:Heterografts; D006736:Horses; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation; D013530:Surgical Wound Infection / Q000601:surgery*; D016019:Survival Analysis