Department of Vascular Surgery, Henri Mondor University Hospital, 51 Avenue Mal de Lattre de Tassigny, 94000 Créteil, France.
Public Health Department, Henri Mondor University Hospital, Créteil, France.
Eur J Vasc Endovasc Surg. 2014 Sep;48(3):292-9. doi: 10.1016/j.ejvs.2014.04.023. Epub 2014 Jun 10.
To evaluate overall survival and complications of cryopreserved arterial allografts in aortic graft infections and infected aortic aneurysms.
A retrospective review of consecutive patients was conducted with native or prosthetic aortic infections, who underwent local debridement and in situ implantation of a cryopreserved aortic allograft from September 2004 to June 2012 at the Henri Mondor University Hospital. Patient characteristics, indications for allograft implantation, perioperative events, bacteriological data, and events related to follow-up were identified. The primary outcome was overall survival. Overall survival was estimated using the Kaplan-Meier method. Predictors of postoperative mortality were identified using uni- and multivariate analysis with a Cox proportional hazard regression.
During the study period, 54 patients (45 [83%] men, mean age 66.2 ± 10.2 years) underwent aortic reconstruction using cryopreserved allografts. Indications were native aortic infection in 17 patients and prosthetic graft infection in 37 patients, including seven aortoenteric fistulae. Twelve aortic reconstructions (22%) were performed as emergency procedures. The median duration of follow-up was 12.1 months (range 0.4-83.6). The 30-day mortality rate was 28%. The overall mortality rate was 39% at a median follow-up of 12.1 months. Early significant postoperative complications occurred in 52% of patients. The graft-related mortality rate was 7%. The graft-related complication rate was 19%. During follow-up, there were two recurrences of aortic infection and two recurrences of allograft limb occlusion. Multivariate survival analysis identified age, chronic renal disease, prosthetic infection, emergent procedure, and coronary disease as independent predictors for postoperative mortality.
This experience with cryopreserved aortic allografts in aortic reconstructions shows an unsatisfactory 30-day survival rate, as well as a substantial early graft-related complication rate. Longer follow-up is needed in order to support the preferential use of cryopreserved allografts based on their long-term behavior.
评估冷冻保存的动脉同种异体移植物在主动脉移植物感染和感染性主动脉瘤中的总生存率和并发症。
对 2004 年 9 月至 2012 年 6 月期间在亨利·蒙多医院因原发性或人工主动脉感染而行局部清创术和原位植入冷冻保存的主动脉同种异体移植物的连续患者进行回顾性分析。确定患者特征、同种异体移植物植入的适应证、围手术期事件、细菌学数据以及与随访相关的事件。主要结果是总生存率。使用 Kaplan-Meier 方法估计总生存率。使用单变量和多变量分析以及 Cox 比例风险回归确定术后死亡率的预测因素。
在研究期间，54 名患者（45 名[83%]男性，平均年龄 66.2±10.2 岁）接受了冷冻保存同种异体移植物的主动脉重建。适应证为 17 例原发性主动脉感染和 37 例人工移植物感染，包括 7 例主动脉肠瘘。12 例（22%）主动脉重建为急诊手术。中位随访时间为 12.1 个月（范围 0.4-83.6）。30 天死亡率为 28%。中位随访 12.1 个月时的总死亡率为 39%。52%的患者早期出现明显的术后并发症。移植物相关死亡率为 7%。移植物相关并发症发生率为 19%。随访期间，有 2 例主动脉感染复发和 2 例同种异体移植物支闭塞复发。多变量生存分析确定年龄、慢性肾功能衰竭、人工感染、急诊手术和冠心病是术后死亡的独立预测因素。
这项使用冷冻保存的主动脉同种异体移植物进行主动脉重建的经验显示，30 天的生存率不理想，并且早期移植物相关并发症发生率较高。需要进行更长时间的随访，以便根据其长期表现支持优先使用冷冻保存的同种异体移植物。
