Long-term outcomes and evolving trends in thoracic aortic infections: A 25-year, single-center study in Japan

Thoracic aortic infection (TAI), including infections of the native aorta, prosthetic graft infections, aortoesophageal fistula, and aortobronchial fistula, remains among the most challenging and fatal diseases. This study aimed to review our 25-year experience with surgical management of TAI.

This retrospective study included 106 participants with TAI from January 2000 to September 2024. The primary end point was hospital mortality. Secondary end points included 30-day mortality, trends in TAI management, overall survival, freedom from infection-related death, and freedom from infection-related events. Subgroup analyses were also conducted. The current surgical strategy has been in use since 2008.

Among 106 participants, 33 (31.1%) had aortoesophageal fistula, 7 (6.6%) had aortobronchial fistula, and 66 (62.2%) had TAI without fistula. Eighty-four participants underwent surgery after 2008. In situ replacement was performed in 85 (80.1%), thoracic endovascular aortic repair in 15 (14.1%), and extra-anatomical bypass in 6 (6%). The 30-day mortality rate was 3.7% (n = 4), and hospital mortality was 16.0% (n = 17). At 10 years, overall survival was 55.4% ± 5.9%, freedom from infection-related death was 78.7% ± 4.3%, and freedom from infection-related events was 76.1% ± 4.4%. Participants who underwent surgery after 2008 had significantly better outcomes than those treated before 2008.

Despite the continued high hospital mortality associated with surgical treatment of TAI, the strategy implemented since 2008 has resulted in improved outcomes. The long-term outcomes were acceptable.