Graft infection after a Bentall procedure: A case series and systematic review of the literature.
BACKGROUND
The Bentall procedure is a cardiac surgery involving graft replacement of the aortic valve, aortic root and ascending aorta. Graft infection after Bentall's procedure (BGI) is infrequent but severe, and often difficult to diagnose and treat.


METHODS
A retrospective cohort study was performed using the Bordeaux endocarditis database of adult patients admitted to the Bordeaux University Medical Hospital for BGI between 2008 and 2014. Published case reports were identified in the literature.


RESULTS
We identified 10 BGI patients in the database and 13 in the literature. The majority of infections were late-onset (20/23) and occurred as a result of gram positive cocci bacterial infection (16/22). Detailed diagnoses of the described BGI were determined using echocardiography, computed tomography (CT) and positron emission tomography/CT (PET/CT). Labeled-leukocyte scintigraphy was not reported in any case. Prolonged antibiotic therapy and surgery were found to be the treatment of choice for BGI; however it was not always possible to perform a surgical intervention. Clinical relapses occurred even with a negative PET/CT, while PET/CT consistently positive for BGI occurred in the absence of clinical relapse. This suggests that the use of PET/CT for follow-up is questionable.


CONCLUSIONS
Diagnosis of BGI is difficult, due to the combination of clinical, biological, and radiological observations obtained through transesophageal echocardiography and CT. PET/CT is an alternative method to diagnosis BGI, but its impact on clinical management remains unclear. Current data suggests that if surgical replacement of the prosthesis is not possible, patients should be treated with prolonged antibiotic therapy.
Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France.
I
I
Machelart
Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France.
C
C
Greib
Department of Infectious Diseases, Pellegrin Hospital, Bordeaux, France.
G
G
Wirth
Medical Intensive Care Unit, Saint André Hospital, Bordeaux, France.
F
F
Camou
Medical Intensive Care Unit, Saint André Hospital, Bordeaux, France.
N
N
Issa
Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France.
J F
JF
Viallard
Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France.
J L
JL
Pellegrin
Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France.
E
E
Lazaro
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001011:Aorta / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery*; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006350:Heart Valve Prosthesis / Q000382:microbiology*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D012189:Retrospective Studies; D019737:Transplants / Q000382:microbiology
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents
Bentall prosthesis; Endocarditis; Vascular graft infection