Replacement of the infected composite aortic root prosthesis

Dipesh K. Shah, Zhuo Li, Soon J Park, Richard C. Daly, Joseph A. Dearani, Hartzell V. Schaff, Thoralf M. Sundt

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Background: We sought to evaluate freedom from reinfection after surgery for infected aortic root replacement (ARR) and the impact of use of synthetic material at reoperation. Methods: Adult patients (aged more than 18 years) undergoing surgery for infected composite aortic root prosthesis at our institution were identified and their perioperative outcomes and late survival evaluated. Results: Between January 1, 1993, and December 31, 2009, 15 patients (male, 87%; mean [SD] age, 57 [16] years) underwent surgery. All but 1 patient (6.7%) underwent reconstruction with a homograft. Eight patients (53.3%) required synthetic material to complete the repair, including 4 patients who underwent hemiarch reconstruction. Ten patients (66.7%) had circulatory arrest (mean [SD] time, 23.3 [11.0] minutes) and 3 (20.0%) underwent concomitant coronary artery bypass grafting. The 30-day mortality rate was 13.3% (n = 2). Three patients (20.0%)2 of whom had positive blood cultures in hospital after redo ARRhad reinfection, for which 2 underwent re-replacement of the aortic root. Survival was 86.7%, 65.0%, and 50.6%, and freedom from reinfection was 90.9%, 79.5%, and 79.5% at 3, 6, and 12 months, respectively. Freedom from reinfection was less for the patients who had positive blood cultures within 2 weeks of redo ARR (p < 0.03) and for patients who had multiple previous sternotomies (p = 0.006). Use of synthetic graft material had no adverse impact. Conclusions: Infected ARR prostheses can be replaced with a homograft with favorable outcomes. Use of synthetic material to complete the repair does not adversely impact outcome.

Original languageEnglish (US)
Pages (from-to)1651-1655
Number of pages5
JournalAnnals of Thoracic Surgery
Volume92
Issue number5
DOIs
StatePublished - Nov 1 2011

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Shah, D. K., Li, Z., Park, S. J., Daly, R. C., Dearani, J. A., Schaff, H. V., & Sundt, T. M. (2011). Replacement of the infected composite aortic root prosthesis. Annals of Thoracic Surgery, 92(5), 1651-1655. https://doi.org/10.1016/j.athoracsur.2011.05.115