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The infected aorta

L K von Segesser1, P Vogt, M Genoni

  • 1Clinics for Cardio-vascular Surgery, University Hospitals, Lausanne, Switzerland.

Journal of Cardiac Surgery
|March 1, 1997
PubMed
Summary
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Severe aortic infections, including mycotic aneurysms, remain lethal. Surgical strategies for aortic infections depend on infection location and graft availability, with varied outcomes across different aortic segments.

Area of Science:

  • Cardiovascular Surgery
  • Infectious Diseases
  • Vascular Surgery

Background:

  • Severe aortic infections leading to mycotic aneurysms present a high mortality rate.
  • Surgical management of these infections is complex and challenging.
  • Despite advances in antibiotic therapy, outcomes remain poor.

Purpose of the Study:

  • To analyze surgical outcomes for severe aortic infections based on anatomical location.
  • To evaluate the effectiveness of different surgical techniques and graft materials.
  • To identify factors influencing patient survival and recurrence rates.

Main Methods:

  • Retrospective analysis of 43 patients with severe aortic infections.
  • Categorization into four groups based on infection location: aortic root, ascending aorta/arch, descending/thoraco-abdominal aorta, and infrarenal aorta.

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  • Surgical interventions included in situ repair with synthetic or biological grafts, homografts, direct suture, and extra-anatomic bypass.

    • Main Results:

    • Outcomes varied significantly by anatomical location and surgical approach.
    • Aortic root infections had high early and late mortality, with homografts showing promise.
    • Descending and thoraco-abdominal aorta repairs utilized cardiopulmonary bypass adjuncts, while infrarenal repairs did not require them.
    • Extra-anatomic bypasses for infrarenal infections showed high rates of thrombosis.

    Conclusions:

    • The anatomical site of the aortic infection is a critical determinant of surgical strategy.
    • The availability of homologous graft material significantly influences treatment decisions.
    • Tailoring surgical approaches to specific aortic segments and graft availability is essential for improving outcomes.