USING AORTIC ALLOGRAFT MATERIAL TO TREAT MYCOTIC-ANEURYSMS OF THE THORACIC AORTA

Background. Although mycotic aneurysms are rare in this age of antibio tics, they nevertheless represent life-threatening lesions of the aort ic wall because of their high incidence of rupture and significantly h igh rate of recurrence. Methods. Between March 1988 and August 1994, c ryopreserved allograft material was used to treat 8 patients (mean age , 62.5 years; range, 47 to 80 years) with mycotic aneurysms of the tho racic aorta at our institution. Two patients had emergency operations; the other operations in 6 patients were elective. The aneurysms were located at the previous cannulation site of the aorta (n = 1) or at th e donor/recipient aortic anastomosis (n = 1) in the patients who had h eart transplantation, in the ascending aorta in 3 patients with aortic valve endocarditis, in the aortic arch in 2, and in the descending ao rta in 1. The operative technique consisted of excision of the mycotic aneurysm followed by allograft patch reconstruction in 5 patients, an allograft composite graft replacement of the ascending aorta in 2 pat ients with endocarditis, and combined aortic allograft root replacemen t and allograft patch reconstruction of the ascending aorta in 1 patie nt. Results. The underlying infections of the aorta were treated succe ssfully in 6 patients. One heart transplant recipient had reoperation because of recurrent mycotic aneurysm after allograft patch reconstruc tion at the donor/recipient anastomosis. There was one early death inv olving a patient with Salmonella sp sepsis. Conclusions. The use of ao rtic allograft material for repairing mycotic aortic aneurysms is a pr omising and effective operative concept for managing thoracic aortic i nfections.