Van Hemelrijck Mathias, Sromicki Juri, Risteski Petar, Boulos Rasha, Buechel Ronny R, Frank Michelle, Hasse Barbara, Rodríguez Cetina Biefer Héctor, Dzemali Omer
Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
Eur J Cardiothorac Surg. 2025 Jun 3;67(6). doi: 10.1093/ejcts/ezaf171.
Thoracic vascular graft infections are devastating complications after aortic surgery, entailing high mortality. The gold standard treatment combines excisional surgery and antimicrobial therapy, but patients deemed inoperable might benefit from a conservative approach. Outcomes of patients treated only with antimicrobial agents without reoperative surgery are scanty. We aim to describe patients' characteristics and outcomes using an antibiotic-only strategy without thorough debridement.
Retrospectively collected data from a prospective cohort in a tertiary centre. Descriptive analysis for baseline characteristics and Kaplan-Meier estimates for survival were performed.
From November 2012 to December 2022, 66 patients were identified with aortic root, ascending aortic and aortic arch graft infections. Of these, 44 received an antibiotic-only strategy or in combination with selective debridement after achieving multidisciplinary consensus. Median follow-up was 4.8 years [interquartile range (IQR) 1.7-6.1], and cumulative survival was 82.9% (CI 95%, 69.7-96.1). Streptococcus spp were the most common isolated microorganisms.
In selected cases, a conservative approach with antibiotics only or in combination with selective debridement showed acceptable results at follow-up, suggesting a valuable therapy option for this cohort of patients.
胸段血管移植物感染是主动脉手术后的灾难性并发症，死亡率很高。金标准治疗方法是手术切除与抗菌治疗相结合，但被认为无法手术的患者可能从保守治疗方法中获益。仅接受抗菌药物治疗而未再次手术的患者的预后情况鲜有报道。我们旨在描述采用仅使用抗生素且不进行彻底清创的策略治疗的患者的特征和预后。
回顾性收集来自一家三级中心前瞻性队列的数据。对基线特征进行描述性分析，并对生存情况进行Kaplan-Meier估计。
2012年11月至2022年12月期间，66例患者被确诊为主动脉根部、升主动脉和主动脉弓移植物感染。其中，44例在达成多学科共识后接受了仅使用抗生素的策略或联合选择性清创。中位随访时间为4.8年[四分位间距（IQR）1.7 - 6.1]，累积生存率为82.9%（95%CI，69.7 - 96.1）。链球菌属是最常见的分离出的微生物。
在特定病例中，仅使用抗生素或联合选择性清创的保守治疗方法在随访中显示出可接受的结果，表明这是该组患者一种有价值的治疗选择。
