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J Thorac Cardiovasc Surg 2007;134:839-843
© 2007 The American Association for Thoracic Surgery

Editorial

Options for managing infected ascending aortic grafts

^a Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
^b Cardiovascular Surgery Service of the Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Tex.

Received for publication May 1, 2007; accepted for publication May 14, 2007.

^_* Address for reprints: Scott A. LeMaire, MD, Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, BCM 390, Houston, TX 77030. (Email: slemaire@bcm.edu).

The first 300 words of the full text of this article appear below.

Infections involving ascending aortic grafts are extremely difficult to eradicate and are frequently lethal. Successfully treating this complication is always challenging and is especially problematic when the infection extends into adjacent prosthetic material in the aortic root—as in patients with composite valve grafts (CVGs)—or in the aortic arch. Although antibiotics are a critical component of treatment, they are rarely effective as the sole form of therapy. Among the many patients described in reports of ascending aortic graft infection, only a handful have been successfully treated with antibiotics alone.^1-4 We¹ previously reported that of 7 patients with infected ascending/arch grafts in whom nonoperative treatment was attempted, medical treatment ultimately failed in 3 (43%), necessitating operation. In 1995, Gott and associates⁴ reported that of 7 patients treated nonoperatively for CVG endocarditis, only 2 (29%) survived. These authors later reported using antibiotics alone to successfully treat 5 patients with Marfan syndrome who had early CVG endocarditis, but the authors emphasized that this treatment approach is not sufficient in patients with severe prosthetic infections.³ In their brief communication in this issue, Akowuah and colleagues⁵ describe treating 2 patients with antibiotics alone; both patients died. The dismal results of nonoperative management justify aggressive surgical treatment of infected ascending aortic grafts.

The cornerstone surgical strategy for treating patients with infected peripheral vascular grafts is graft removal and extra-anatomic bypass. Although technically possible,⁶ extra-anatomic bypass is not suitable for managing ascending aortic graft infections; therefore, the surgical options involve either salvaging the existing graft or replacing it in situ. In either case, the need to leave prosthetic material in an infected surgical field makes it difficult to eradicate the infection. In 1984, Hargrove and Edmunds⁷ introduced guidelines to address this problem, emphasizing the need for prompt and thorough surgical debridement, antiseptic irrigation, and appropriate antibiotic therapy. Notably, . . . [Full Text of this Article]

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Management of prosthetic graft infection after surgery of the thoracic aorta: Removal of the prosthetic graft is not necessary

Enoch Akowuah, Pradeep Narayan, Gianni Angelini, and Alan J. Bryan
J. Thorac. Cardiovasc. Surg. 2007 134: 1051-1052. [Extract] [Full Text] [PDF]

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