Author(s):
Janko, Matthew ; Hubbard, Grant ; Woo, Karen ; Kashyap, Vikram S. ; Mitchell, Megan ; Murugesan, Arun ; Chen, Lin ; Gardner, Rachel ; Baril, Donald ; Hacker, Robert I. ; Szeberin, Zoltan ; ElSayed, Ramsey ; Magee, Gregory A. ; Motta, Fernando ; Zhou, Wei ; Lemmon, Gary ; Coleman, Dawn ; Behrendt, Christian-Alexander ; Aziz, Faisal ; Black, James H. ; Tran, Kimberly ; Dao, Allen ; Shutze, William ; Garrett, H. Edward ; De Caridi, Giovanni ; Patel, Rhusheet ; Liapis, Christos D. ; Geroulakos, George ; Kakisis, John ; Moulakakis, Konstantinos ; Kakkos, Starvos K. ; Obara, Hideaki ; Wang, Grace ; Stoecker, Jordan ; Rhéaume, Pascal ; Davila, Victor ; Ravin, Reid ; DeMartino, Randall ; Milner, Ross ; Shalhub, Sherene ; Jim, Jeffrey ; Lee, Jason ; Dubuis, Celine ; Ricco, Jean-Baptiste ; Coselli, Joseph ; Lemaire, Scott ; Fatima, Javairiah ; Sanford, Jennifer ; Yoshida, Winston [UNESP] ; Schermerhorn, Marc L ; Menard, Matthew ; Belkin, Michael ; Blackwood, Stuart ; Conrad, Mark ; Wang, Linda ; Crofts, Sara ; Nixon, Thomas ; Wu, Timothy ; Chiesa, Roberto ; Bose, Saideep ; Turner, Jason ; Moore, Ryan ; Smith, Justin ; Irshad, Ali ; Hsu, Jeffrey ; Czerny, Martin ; Cullen, Jonathan ; Kahlberg, Andrea ; Setacci, Carlo ; Joh, Jin Hyun ; Senneville, Eric ; Garrido, Pedro ; Sarac, Timur P. ; Rizzo, Anthony ; Go, Michael R. ; Bjorck, Martin ; Gavali, Hamid ; Wanhainen, Anders ; D'Oria, Mario ; Lepidi, Sandro ; Mastrorilli, Davide ; Veraldi, Gianfranco ; Piazza, Michele ; Squizzato, Francesco ; Beck, Adam ; St. John, Rebecca ; Wishy, Andrew ; Humphries, Misty ; Shah, Samir K. ; Back, Martin ; Chung, Jayer ; Lawrence, Peter F ; Bath, Jonathan ; Smeds, Matthew R.
Date: 2022
Persistent ID: http://hdl.handle.net/11449/222821
Origin: Oasisbr
Description
Made available in DSpace on 2022-04-28T19:47:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-10-01
Introduction: Aortic graft infection remains a considerable clinical challenge, and it is unclear which variables are associated with adverse outcomes among patients undergoing partial resection. Methods: A retrospective, multi-institutional study of patients who underwent partial resection of infected aortic grafts from 2002 to 2014 was performed using a standard database. Baseline demographics, comorbidities, operative, and postoperative variables were recorded. The primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM) survival analysis, and Cox regression analysis were performed. Results: One hundred fourteen patients at 22 medical centers in 6 countries underwent partial resection of an infected aortic graft. Seventy percent were men with median age 70 years. Ninety-seven percent had a history of open aortic bypass graft: 88 (77%) patients had infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac bypass, and 1 (0.8%) had an infected thoracic graft. Infection was diagnosed at a median 4.3 years post-implant. All patients underwent partial resection followed by either extra-anatomic (47%) or in situ (53%) vascular reconstruction. Median follow-up period was 17 months (IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated median survival from time of partial resection was 3.6 years. There was no significant survival difference between those undergoing in situ reconstruction or extra-anatomic bypass (P = 0.6). During follow up, 72% of repairs remained patent and 11% of patients underwent major amputation. On univariate Cox regression analysis, Candida infection was associated with increased risk of mortality (HR 2.4; P = 0.01) as well as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft limb only to resection of abdominal (graft main body) infection was associated with decreased risk of mortality (HR 0.57, P = 0.04), as well as those with American Society of Anesthesiologists classification less than 3 (HR 0.35, P = 0.04). Multivariate analysis did not reveal any factors significantly associated with mortality. Persistent early infection was noted in 26% of patients within 30 days postoperatively, and 39% of patients were found to have any post-repair infection during the follow-up period. Two patients (1.8%) were found to have a late reinfection without early persistent postoperative infection. Patients with any post-repair infection were older (67 vs. 60 years, P = 0.01) and less likely to have patent repairs during follow up (59% vs. 32%, P = 0.01). Patients with aortoenteric fistula had a higher rate of any post-repair infection (63% vs. 29%, P < 0.01) Conclusion: This large multi-center study suggests that patients who have undergone partial resection of infected aortic grafts may be at high risk of death or post-repair infection, especially older patients with abdominal infection not isolated to a single graft limb, or with Candida infection or aortoenteric fistula. Late reinfection correlated strongly with early persistent postoperative infection, raising concern for occult retained infected graft material.
University Hospitals Cleveland Medical Center Case Western Reserve University School of Medicine
the Ronald Reagan UCLA Medical Center University of California Los Angeles
SSM Healthcare
Semmelweis University
Keck School of Medicine University of Southern California
University of North Carolina School of Medicine
University of Arizona
the Indiana University Health Physicians Vascular Surgery
Michigan Medicine University of Michigan
University Heart Center Hamburg University Medical Center Hamburg-Eppendorf
Penn State Heart and Vascular Institute Milton S. Hershey Medical Center
Johns Hopkins Hospital
The Heart Hospital Baylor Plano
the Cardiovascular Surgery Clinic
University of Messina
National & Kapodistrian University of Athens
University of Patras
Keio University
University of Pennsylvania
Vancouver General Hospital & University of British Columbia
Mayo Clinic
Christiana Health System
University of Chicago
Harborview Medical Center University of Washington
Washington University
Stanford University
CHU de Poitiers
Baylor College of Medicine
MedStar Georgetown University Hospital
SSM Health St. Louis University
Faculdade de Medicina de Botucatu-Unesp
Beth Israel Deaconness Medical Center
Brigham and Women's Hospital
St. Joseph's Hospital
Massachusetts General Hospital
Robert Wood Johnson Medical School Rutgers University
Vita-Salute University School of Medicine San Raffaele Scientific Institute
Kaiser Permanente
University Heart Center Freiburg-Bad Krozingen Freiburg
University of Virginia Medical Center
University of Siena
Kyung Hee University
Gustave Dron Hospital
Centro Hospitalar de Lisboa Norte
Wexner Medical Center Ohio State University
Uppsala University
University Hospital of Trieste
University Hospital of Verona
University Hospital of Padova
University of Alabama
University of California Davis
University of Florida
Michael E. DeBakey Department of Surgery Baylor College of Medicine
University Hospital University of Missouri
Faculdade de Medicina de Botucatu-Unesp
