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J Thorac Cardiovasc Surg 1998;116:965-972
© 1998 Mosby, Inc.

SURGERY FOR ADULT CARDIOVASCULAR DISEASE

CRYOPRESERVED ARTERIAL ALLOGRAFTS IN THE TREATMENT OF MAJOR VASCULAR INFECTION: A COMPARISON WITH CONVENTIONAL SURGICAL TECHNIQUES

From the Clinic for Cardiovascular Surgery,^a the Divisions of Cardiology^b and Infectious Diseases,^c the Clinic for Radiology,^d and the Department of Biostatistics, ISPM,^e University Hospital Zurich, Switzerland.

Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.

Received for publication May 8, 1998. Revisions requested July 2, 1998.Revisions received July 30, 1998. Accepted for publication Aug 20, 1998. Address for reprints: Paul R. Vogt, MD, Clinic for Cardiovascular Surgery, University Hospital Zurich, Rämistr 100, CH-8091 Zurich, Switzerland.

Objective: Recent findings with cryopreserved heart valve allografts in the treatment of infectious endocarditis suggest that the use of cryopreserved arterial allografts may improve the outcome in patients with vascular infections.
Methods: Seventy-two patients with mycotic aneurysms (n = 29) or infected vascular prostheses (n = 43) of the thoracic (n = 26) or abdominal aorta (n = 46) were treated with in situ repair and extra-anatomic reconstruction using prosthetic material (n = 38) or implantation of a cryopreserved arterial allograft (n = 34). Disease-related survival and survival free of reoperation were assessed. Morbidity, cumulative lengths of intensive care, hospitalization, antibiotic treatment, and costs were calculated per year of follow-up.
Results: The use of cryopreserved arterial allografts was superior to conventional surgery in terms of disease-related survival (P = .008), disease-related survival free of reoperation (P = .0001), duration of intensive care per year of follow-up (median 1 vs 11 days; range 1 to 42 vs 2 to 120 days; P = .001), hospitalization (14 vs 30 days; range 7 to 150 vs 15 to 240 days; P = .002), duration of postoperative antibiotic therapy (21 vs 40 days; range 21 to 90 vs 60 to 365 days; P = .002), incidence of complications (24% vs 63%; P = .005), and elimination of infection (91% vs 53%; P = .001). In addition, costs were 40% lower in the group treated by allografts (P = .005).
Conclusions: The use of cryopreserved arterial allografts is a more effective treatment for mycotic aneurysms and infected vascular prostheses than conventional surgical techniques.

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