Xenopericardial roll graft replacement for infectious pseudoaneurysms and graft infections of the aorta

作者：Kubota Hiroshi^*; Endo Hidehito; Noma Mio; Ishii Hikaru; Tsuchiya Hiroshi; Yoshimoto Akihiro; Takahashi Yu; Inaba Yusuke; Nishino Yoshifumi; Nunokawa Masao; Hosoi Yutaka; Ikezoe Tooru; Nemoto Masaru; Makino Yoshihisa; Nemoto Yoko; Matsukura Mitsuru; Sugiyama Masanori; Abe Nobutsugu; Takeuchi Hirohisa; Nagao Gen; Kondo Eri; Yanagida Osamu; Yoshino Hideaki; Sudo Kenichi

来源：Journal of Cardiothoracic Surgery, 2015, 10(1): 133.

DOI：10.1186/s13019-015-0343-5

• Aortic operation
• Pseudoaneurysm
• Biomaterials
• Esophageal injury
• Esophageal perforation
• Infection
• Graft infection
• Xenograft
• Equine pericardium
• Bovine pericardium

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, noninfectious 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 (similar to 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.

• 出版日期2015-10-27