[In situ replacement with cryopreserved homografts for infected aortic prostheses]

Although the incidence is rare, aortic prosthetic graft infection represents one of the most serious and challenging complications for cardiovascular surgeons. The basic strategy in the management of aortic graft infection consists of excision of the infected graft, debridement, reconstruction of the distal blood supply, and prolonged antibiotic therapy. As the most reliable procedure, in situ replacement with cryopreserved allografts has been used in our institution since 1998. The overall in-hospital mortality was 43%, higher than in other reports, because of a higher rate of thoracic cases and longer history before surgical intervention in previous reports. All but one survivor have been free from recurrent infection. In situ replacement with a cryopreserved allograft appears to be the best method, although an allograft is not an omnipotent material in patients with abscess formation. Preoperative drainage and irrigation, and allograft replacement with concomitant use of the omentum, would improve the outcome in the future.