Management of thoracic aortic graft infections

Background. We reviewed our experience managing patients with thoracic aort ic graft infections to evaluate their clinical characteristics and outcomes of treatment. Methods. Records of 20 consecutive patients with thoracic aortic graft infe ctions managed over a 7 year period were retrospectively reviewed. Current follow-up status was obtained for all survivors. Results. Nineteen patients (95%) underwent surgical treatment. Graft excisi on and in situ replacement were performed using Dacron grafts (10/19, 53%) or cryopreserved homografts (5/19, 26%). Three pseudoaneurysms were managed by debridement and primary repair. Although 30 day postoperative survival was 89% (17/19), in-hospital mortality occurred in 8 patients (42%). Infect ed thoracoabdominal aortic grafts were universally fatal. Of 6 patients wit h infected composite valve grafts, both patients who received new composite valve grafts died and all 4 who received homografts survived (p 0.067). Conclusions. infections involving thoracic aortic grafts continue to carry a high mortality rate, especially in patients with polymicrobial infections , thoracoabdominal aortic graft infections, and composite valve graft infec tions. Use of homografts in the latter situation may improve outcome. (C) 1 999 by The Society of Thoracic Surgeons.