FRESH AND CRYOPRESERVED ARTERIAL HOMOGRAFTS IN THE TREATMENT OF PROSTHETIC GRAFT INFECTIONS - EXPERIENCE OF THE ITALIAN COLLABORATIVE VASCULAR HOMOGRAFT GROUP

Following the experience of cardiac surgeons with homografts in the tr eatment of infective aortic valve endocarditis, cardiovascular surgeon s have investigated in situ revascularization by means of homografts i n the management of vascular prosthetic graft infections. Preliminary results are encouraging, but their late fate in long-term follow-up an d the influence of preservation techniques are still under investigati on. This article reports the experience of the Italian Collaborative V ascular Homograft Group, with the use of fresh and cryopreserved arter ial homografts for the treatment of prosthetic graft infections. Betwe en March 1994 and December 1996, 44 patients with prosthetic graft inf ection were treated with homografts (13 preserved at 4 degrees C, 31 c ryopreserved). The mean age of the patients was 65 years. Emergency su rgical procedures were performed in eight patients (18%). Sepsis was d iagnosed in 11 patients, aortoenteric fistula in 13, and false aneurys ms in 10. Staphylococcus was the main cause of infection. The types of vascular reconstruction with homograft were: 32 aortobifemoral, 3 aor toaortic, 2 iliofemoral, 4 peripheral, and 3 axillobifemoral. Human ly mphocyte antigen (HLA) and antibody (ABO) blood group system compatibi lity between donors and recipients was not respected. The mean duratio n of follow-up was 15 months (range 1-33). Clinical and duplex scannin g evaluations were routinely performed. Computed tomography (CT) or ma gnetic resonance (MR) scanning or arteriography were performed on the basis of duplex scanning results. There were six deaths during the ear ly postoperative period (30 days) with a mortality rate of 13.6%. Duri ng the follow-up there were five late deaths with a mortality rate of 11.4%. Eight patients had graft occlusion. Three cases were successful ly treated with thrombectomy. Two cases were successfully treated with femoropopliteal bypass with autologous vein. In three cases leg amput ation was necessary. The results of fresh and cryopreserved homograft were compared. No significative differences of early postoperative mor tality, late mortality, homograft related mortality, and graft occlusi on were observed. We have evaluated the actuarial survival of the pati ents and the actuarial patency of the homografts on the aortoiliac rec onstructions. Twelve months after the surgery the actuarial survival o f the patients was 73% and the actuarial patency of the homografts was 56%. In our preliminary experience, we have not observed any signific ant difference in terms of clinical outcome by using fresh rather than cryopreserved homografts. In the near future it will be our policy to employ only cryopreserved homografts. Moreover, we wilt extend vessel harvesting to nonheart-beating donors, thus maximizing retrieval. The aforementioned solutions will supply the best graft availability to o btain dimensional and ABO compatibility between donors and recipients.