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Using aortic allograft material to treat mycotic aneurysms of the thoracic aorta
C Knosalla1, Y Weng, A C Yankah
1Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Germany.
Background:
Although mycotic aneurysms are rare in this age of antibiotics, they nevertheless represent life-threatening lesions of the aortic wall because of their high incidence of rupture and significantly high rate of recurrence.
Methods:
Between March 1988 and August 1994, cryopreserved allograft material was used to treat 8 patients (mean age, 62.5 years; range, 47 to 80 years) with mycotic aneurysms of the thoracic aorta at our institution. Two patients had emergency operations; the other operations in 6 patients were elective. The aneurysms were located at the previous cannulation site of the aorta (n = 1) or at the donor/recipient aortic anastomosis (n = 1) in the patients who had heart transplantation, in the ascending aorta in 3 patients with aortic valve endocarditis, in the aortic arch in 2, and in the descending aorta in 1. The operative technique consisted of excision of the mycotic aneurysm followed by allograft patch reconstruction in 5 patients, an allograft composite graft replacement of the ascending aorta in 2 patients with endocarditis, and combined aortic allograft root replacement and allograft patch reconstruction of the ascending aorta in 1 patient.
Results:
The underlying infections of the aorta were treated successfully in 6 patients. One heart transplant recipient had reoperation because of recurrent mycotic aneurysm after allograft patch reconstruction at the donor/recipient anastomosis. There was one early death involving a patient with Salmonella sp sepsis.
Conclusions:
The use of aortic allograft material for repairing mycotic aortic aneurysms is a promising and effective operative concept for managing thoracic aortic infections.
Insights
Aortic allografts offer a promising solution for treating life-threatening mycotic aneurysms. This study shows effective management of thoracic aortic infections using allograft materials in surgical repair.
Area of Science:
- Cardiovascular Surgery
- Infectious Disease
- Vascular Surgery
Background:
- Mycotic aneurysms are rare but life-threatening aortic wall lesions.
- High rates of rupture and recurrence make them challenging clinical problems.
Purpose of the Study:
- To evaluate the efficacy of cryopreserved allograft material in treating mycotic aneurysms of the thoracic aorta.
Main Methods:
- Eight patients with thoracic aortic mycotic aneurysms underwent surgical repair using cryopreserved allografts between 1988 and 1994.
- Procedures included allograft patch reconstruction, composite graft replacement, and aortic allograft root replacement.
Main Results:
- Successful treatment of underlying aortic infections in six out of eight patients.
- One case of reoperation for recurrent mycotic aneurysm in a heart transplant recipient.
- One early death occurred in a patient with Salmonella sepsis.
Conclusions:
- Aortic allograft material represents a promising and effective surgical strategy for managing thoracic aortic infections.
- Allograft repair is a viable option for complex mycotic aneurysm cases.