PMID- 28009947
OWN - NLM
STAT- MEDLINE
DCOM- 20180419
LR  - 20180419
IS  - 0966-8519 (Print)
IS  - 0966-8519 (Linking)
VI  - 25
IP  - 4
DP  - 2016 Jul
TI  - Root Replacement for Graft Infection Using an All-Biologic Xenopericardial 
      Conduit.
PG  - 440-447
LID - 4320 [pii]
AB  - BACKGROUND AND AIM OF THE STUDY: The management of graft infection following 
      ascending aortic replacement (AAR) and/or aortic valve replacement (AVR) with 
      destruction of the root remains a challenge. Besides technical issues, the choice 
      of graft material is controversial. The study aim was to investigate the initial 
      results of aortic root replacement (ARR) as redo-surgery for infection using the 
      xenopericardial all-biologic conduit (BioIntegral) as an alternative to a 
      homograft or prosthetic material. METHODS: Between February 2013 and January 
      2015, a total of 18 consecutive patients (16 males, two females; mean age 61 +/- 14 
      years) were reoperated on for infection at a mean of 55 +/- 61 months (range: 3 to 
      219 months) following previous AVR (n = 6), supracoronary aortic replacement 
      (SAR, n = 2), AVR + SAR (n = 1), root replacement (n = 7), and root 
      reconstruction (n = 2). Two patients (11%) had undergone more than one previous 
      cardiac operation. Signs of infection were seen on computed tomography (CT) 
      scanning in 17 patients (94%). Additional 18F-FDG PET-CT was performed in nine 
      patients (50%). RESULTS: The cardiopulmonary bypass and crossclamp were 289 +/- 77 
      min and 187 +/- 59 min, respectively. Hypothermic circulatory arrest (HCA) + 
      selective antegrade cerebral perfusion (SACP) was necessary in nine patients 
      (50%) and concomitant procedures in 11 (61%). Postcardiotomy extracorporeal life 
      support (ECLS) was necessary in five patients, and renal replacement therapy in 
      eight. One patient died intraoperatively, and the overall 30-day mortality was 
      22% (n = 4) secondary to multi-organ failure. Risk factors for mortality were 
      myocardial failure requiring ECLS (p = 0.02) and the need for root replacement 
      following previous isolated AVR (p = 0.05). The mean follow up was 12 +/- 5 months. 
      Early graft reinfection occurred in one patient (6%), and another presented with 
      pleural empyema without evidence of persisting conduit infection. Thus, freedom 
      from graft reinfection was 94%. No case of structural valve deterioration was 
      seen. CONCLUSIONS: Aortic root replacement using a xenopericardial conduit in 
      patients with graft infection is technically feasible. Hemodynamics and surgical 
      handling are comparable to that of homografts, but the off-the-shelf availability 
      favors this approach. Mortality was substantial but comparable to that of other 
      series and grafts, with low reinfection rates. Long-term outcome regarding the 
      eradication of infection and durability of the graft remains to be demonstrated.
FAU - Guenther, Sabina PW
AU  - Guenther SP
AD  - Department of Cardiac Surgery, University Hospital Munich, 
      Ludwig-Maximilian-University, Munich, Germany. Electronic correspondence: 
      sabina.guenther@med.uni-muenchen.de.
FAU - Reichelt, Angela
AU  - Reichelt A
AD  - Institute of Clinical Radiology, University Hospital Munich, 
      Ludwig-Maximilian-University, Munich, Germany.
FAU - Peterss, Sven
AU  - Peterss S
AD  - Department of Cardiac Surgery, University Hospital Munich, 
      Ludwig-Maximilian-University, Munich, Germany.
FAU - Luehr, Maximilian
AU  - Luehr M
AD  - Department of Cardiac Surgery, University Hospital Munich, 
      Ludwig-Maximilian-University, Munich, Germany.
FAU - Bagaev, Erik
AU  - Bagaev E
AD  - Department of Cardiac Surgery, University Hospital Munich, 
      Ludwig-Maximilian-University, Munich, Germany.
FAU - Hagl, Christian
AU  - Hagl C
AD  - Department of Cardiac Surgery, University Hospital Munich, 
      Ludwig-Maximilian-University, Munich, Germany.
FAU - Pichlmaier, Maximilian A
AU  - Pichlmaier MA
AD  - Department of Cardiac Surgery, University Hospital Munich, 
      Ludwig-Maximilian-University, Munich, Germany.
FAU - Khaladj, Nawid
AU  - Khaladj N
AD  - Department of Cardiac Surgery, University Hospital Munich, 
      Ludwig-Maximilian-University, Munich, Germany.
LA  - eng
PT  - Journal Article
PL  - England
TA  - J Heart Valve Dis
JT  - The Journal of heart valve disease
JID - 9312096
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Aorta/*surgery
MH  - Aortic Valve/*surgery
MH  - *Bioprosthesis
MH  - Female
MH  - Heart Valve Prosthesis Implantation/*adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prosthesis-Related Infections/*surgery
MH  - Retrospective Studies
EDAT- 2016/12/24 06:00
MHDA- 2016/12/24 06:01
CRDT- 2016/12/24 06:00
PHST- 2016/12/24 06:00 [entrez]
PHST- 2016/12/24 06:00 [pubmed]
PHST- 2016/12/24 06:01 [medline]
AID - 4320 [pii]
PST - ppublish
SO  - J Heart Valve Dis. 2016 Jul;25(4):440-447.