Infection of Ascending Aortic and Aortic Arch Prostheses

  • Maximilian Luehr
  • Maximilian A. PichlmaierEmail author


Bacterial infection of artificial vascular grafts is generally an uncommon but devastating complication of any type of vascular reconstructive surgery. At the early stage of infection, the clinical symptoms may be vague and non-specific, resulting in a delay of the correct diagnosis, with patients presenting more often at a late stage of the disease process. Conservative measures, by means of non-surgical treatment alone, are usually reported to fail with very high mortality rates. However, medical treatment alone or as an adjunct to less aggressive surgical treatment stratagems may be still considered for long-term control of the infection, when more definitive forms of surgical treatment are preclusive.


Graft infection Sepsis Mycosis Biofilm Serology Endovascular Pharmacology 


  1. 1.
    Khaladj N, Pichlmaier U, Stachmann A, Peterss S, Reichelt A, Hagl C, et al. Cryopreserved human allografts (homografts) for the management of graft infections in the ascending aortic position extending to the arch. Eur J Cardiothorac Surg. 2013;43:1170–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Hargrove WC, Edmunds LH. Management of infected thoracic aortic prosthetic grafts. Ann Thorac Surg. 1984;37:72–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Tossios P, Karatzopoulos A, Tsagakis K, Sapalidis K, Grosomanidis V, Kalogera A, et al. Treatment of infected thoracic aortic prosthetic grafts with the in situ preservation strategy: a review of its history, surgical technique, and results. Heart Lung Circ. 2014;23:24–31.PubMedCrossRefGoogle Scholar
  4. 4.
    Kahlberg A, Melissano G, Tshomba Y, Leopardi M, Chiesa R. Strategies to treat thoracic aortitis and infected aortic grafts. J Cardiovasc Surg (Torino). 2015;56:269–80.Google Scholar
  5. 5.
    Gott VL, Gillinov AM, Pyeritz RE, Cameron DE, Reitz BA, Greene PS, et al. Aortic root replacement. Risk factor analysis of a seventeen-year experience with 270 patients. J Thorac Cardiovasc Surg. 1995;109:536–45.PubMedCrossRefGoogle Scholar
  6. 6.
    LeMaire SA, Coselli JS. Options for managing infected ascending aortic grafts. J Thorac Cardiovasc Surg. 2007;134:839–43.PubMedCrossRefGoogle Scholar
  7. 7.
    Akowuah E, Narayan P, Angelini G, Bryan AJ. Management of prosthetic graft infection after surgery of the thoracic aorta: removal of the prosthetic graft is not necessary. J Thorac Cardiovasc Surg. 2007;134:1051–2.PubMedCrossRefGoogle Scholar
  8. 8.
    Erb S, Sidler JA, Elzi L, Gurke L, Battegay M, Widmer AF, et al. Surgical and antimicrobial treatment of prosthetic vascular graft infections at different surgical sites: a retrospective study of treatment outcomes. PLoS One. 2014;9:e112947.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Teebken OE, Bisdas T, Assadian O, Ricco J-B. Recommendations for reporting treatment of aortic graft infections. Eur J Vasc Endovasc Surg. 2012;43:174–81.PubMedCrossRefGoogle Scholar
  10. 10.
    Umminger J, Krueger H, Beckmann E, Kaufeld T, Fleissner F, Haverich A, et al. Management of early graft infections in the ascending aorta and aortic arch: a comparison between graft replacement and graft preservation techniques. Eur J Cardiothorac Surg. 2016;50:660–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Czerny M, von Allmen R, Opfermann P, Sodeck G, Dick F, Stellmes A, et al. Self-made pericardial tube graft: a new surgical concept for treatment of graft infections after thoracic and abdominal aortic procedures. Ann Thorac Surg. 2011;92:1657–62.PubMedCrossRefGoogle Scholar
  12. 12.
    Yamanaka K, Omura A, Nomura Y, Miyahara S, Shirasaka T, Sakamoto T, et al. Surgical strategy for aorta-related infection. Eur J Cardiothorac Surg. 2014;46:974–80.PubMedCrossRefGoogle Scholar
  13. 13.
    Coselli JS, Köksoy C, LeMaire SA. Management of thoracic aortic graft infections. Ann Thorac Surg. 1999;67:1990–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Keidar Z, Nitecki S. FDG-PET in prosthetic graft infections. Semin Nucl Med. 2013;43:396–402.PubMedCrossRefGoogle Scholar
  15. 15.
    Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350:1422–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Guenther SPW, Cyran CC, Rominger A, Saam T, Kazmierzcak PM, Bagaev E, et al. The relevance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging in diagnosing prosthetic graft infections post cardiac and proximal thoracic aortic surgery. Interact Cardiovasc Thorac Surg. 2015;21:450–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2873–926.PubMedCrossRefGoogle Scholar
  18. 18.
    Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121:e266–369.PubMedGoogle Scholar
  19. 19.
    Coselli JS, Crawford ES, Williams TW, Bradshaw MW, Wiemer DR, Harris RL, et al. Treatment of postoperative infection of ascending aorta and transverse aortic arch, including use of viable omentum and muscle flaps. Ann Thorac Surg. 1990;50:868–81.PubMedCrossRefGoogle Scholar
  20. 20.
    Aguado JM, Valle R, Arjona R, Ferreres JC, Gutierrez JA. Aortic bypass graft infection due to Aspergillus: report of a case and review. Clin Infect Dis. 1992;14:916–21.PubMedCrossRefGoogle Scholar
  21. 21.
    Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG, Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Hollander JE, Quick G. Aortoesophageal fistula: a comprehensive review of the literature. Am J Med. 1991;91:279–87.PubMedCrossRefGoogle Scholar
  23. 23.
    Luehr M, Etz CD, Nozdrzykowski M, Garbade J, Lehmkuhl L, Schmidt A, et al. Emergency open surgery for aorto-oesophageal and aorto-bronchial fistulae after thoracic endovascular aortic repair: a single-centre experience. Eur J Cardiothorac Surg. 2014;47:374–82.PubMedCrossRefGoogle Scholar
  24. 24.
    Haverich A, Hirt S, Karck M, Siclari F, Wahlig H. Prevention of graft infection by bonding of gentamycin to Dacron prostheses. J Vasc Surg. 1992;15:187–93.PubMedCrossRefGoogle Scholar
  25. 25.
    Treska V, Certik B, Molacek J. Management of aortic graft infections - the present strategy and future perspectives. Bratisl Lek Listy. 2016;117:125–32.PubMedGoogle Scholar
  26. 26.
    Herscu G, Wilson SE. Prosthetic infection: lessons from treatment of the infected vascular graft. Surg Clin North Am. 2009;89:391–401.PubMedCrossRefGoogle Scholar
  27. 27.
    Perera GB, Fujitani RM, Kubaska SM. Aortic graft infection: update on management and treatment options. Vasc Endovascular Surg. 2006;40:1–10.PubMedCrossRefGoogle Scholar
  28. 28.
    Ducasse E, Calisti A, Speziale F, Rizzo L, Misuraca M, Fiorani P. Aortoiliac stent graft infection: current problems and management. Ann Vasc Surg. 2004;18:521–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Fourneau I, Nevelsteen A, Lacroix H, Suy R. Microbiological monitoring of aortic aneurysm sac contents during abdominal aneurysmectomy: results in 176 patients and review of the literature. Acta Chir Belg. 1996;96:119–22.PubMedGoogle Scholar
  30. 30.
    Vogel TR, Symons R, Flum DR. The incidence and factors associated with graft infection after aortic aneurysm repair. J Vasc Surg. 2008;47:264–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Trautt E, Thomas S, Ghosh J, Newton P, Cockcroft A. Occult bacteraemia and aortic graft infection: a wolf in sheep’s clothing. Case Rep Vasc Med. 2013;2013:968542.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Arima H, Nagata M, Fujisaki K, Gushima M, Matsumura K, Fujii K, et al. GRAFT infection of thoracic aorta due to group C beta-hemolytic streptococcus—a case report. Angiology. 2005;56:237–41.PubMedCrossRefGoogle Scholar
  33. 33.
    Brook I. Role of anaerobic bacteria in aortofemoral graft infection. Surgery. 1988;104:843–5.PubMedGoogle Scholar
  34. 34.
    Vogt PR, von Segesser LK, Goffin Y, Pasic M, Turina MI. Cryopreserved arterial homografts for in situ reconstruction of mycotic aneurysms and prosthetic graft infection. Eur J Cardiothorac Surg. 1995;9:502–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Teebken OE, Pichlmaier MA, Brand S, Haverich A. Cryopreserved arterial allografts for in situ reconstruction of infected arterial vessels. Eur J Vasc Endovasc Surg. 2004;27:597–602.PubMedCrossRefGoogle Scholar
  36. 36.
    Hodgkiss-Harlow KD, Bandyk DF. Antibiotic therapy of aortic graft infection: treatment and prevention recommendations. Semin Vasc Surg. 2011;24:191–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Nicolini F, Budillon AM, Borrello B, Gherli T. Ascending aortic graft thrombosis from an endoluminal candida albicans infection. Eur J Cardiothorac Surg. 2015;47:e233–4.PubMedCrossRefGoogle Scholar
  38. 38.
    Doscher W, Krishnasastry KV, Deckoff SL. Fungal graft infections: case report and review of the literature. J Vasc Surg. 1987;6:398–402.PubMedCrossRefGoogle Scholar
  39. 39.
    Guan XL, Wang XL, Liu YY, Lan F, Gong M, Li HY, et al. Changes in the hemostatic system of patients with acute aortic dissection undergoing aortic arch surgery. Ann Thorac Surg. 2016;101:945–51.PubMedCrossRefGoogle Scholar
  40. 40.
    Bove T, Calabrò MG, Landoni G, Aletti G, Marino G, Crescenzi G, et al. The incidence and risk of acute renal failure after cardiac surgery. J Cardiothorac Vasc Anesth. 2004;18:442–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Lenos A, Bougioukakis P, Irimie V, Zacher M, Diegeler A, Urbanski PP. Impact of surgical experience on outcome in surgery of acute type A aortic dissection. Eur J Cardiothorac Surg. 2015;48:491–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Khaja MS, Sildiroglu O, Hagspiel K, Rehm PK, Cherry KJ, Turba UC. Prosthetic vascular graft infection imaging. Clin Imaging. 2013;37:239–44.PubMedCrossRefGoogle Scholar
  43. 43.
    Chrapko BE, Chrapko M, Nocuń A, Stefaniak B, Zubilewicz T, Drop A. Role of 18F-FDG PET/CT in the diagnosis of inflammatory and infectious vascular disease. Nucl Med Rev Cent East Eur. 2016;19:28–36.PubMedCrossRefGoogle Scholar
  44. 44.
    Kanemitsu S, Shimono T, Nakamura A, Yamamoto K, Wada H, Shimpo H. Molecular diagnosis of nonaneurysmal infectious aortitis. J Vasc Surg. 2011;53:472–4.PubMedCrossRefGoogle Scholar
  45. 45.
    Legout L, D’Elia PV, Sarraz-Bournet B, Haulon S, Meybeck A, Senneville E, et al. Diagnosis and management of prosthetic vascular graft infections. Med Mal Infect. 2012;42:102–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Fiorani P, Speziale F, Rizzo L, De Santis F, Massimi GJ, Taurino M, et al. Detection of aortic graft infection with leukocytes labeled with technetium 99m-hexametazime. J Vasc Surg. 1993;17:87–96.PubMedCrossRefGoogle Scholar
  47. 47.
    Low RN, Wall SD, Jeffrey RB, Sollitto RA, Reilly LM, Tierney LM. Aortoenteric fistula and perigraft infection: evaluation with CT. Radiology. 1990;175:157–62.PubMedCrossRefGoogle Scholar
  48. 48.
    Orton DF, LeVeen RF, Saigh JA, Culp WC, Fidler JL, Lynch TJ, et al. Aortic prosthetic graft infections: radiologic manifestations and implications for management. Radiographic. 2000;20:977–93.CrossRefGoogle Scholar
  49. 49.
    Shahidi S, Eskil A, Lundof E, Klaerke A, Jensen BS. Detection of abdominal aortic graft infection: comparison of magnetic resonance imaging and indium-labeled white blood cell scanning. Ann Vasc Surg. 2007;21:586–92.PubMedCrossRefGoogle Scholar
  50. 50.
    Evangelista A. Imaging aortic aneurysmal disease. Heart. 2014;100:909–15.PubMedCrossRefGoogle Scholar
  51. 51.
    Liberatore M, Iurilli AP, Ponzo F, Prosperi D, Santini C, Baiocchi P, et al. Clinical usefulness of technetium-99m-HMPAO-labeled leukocyte scan in prosthetic vascular graft infection. J Nucl Med. 1998;39:875–9.PubMedGoogle Scholar
  52. 52.
    McKeown PP, Miller DC, Jamieson SW, Mitchell RS, Reitz BA, Olcott C, et al. Diagnosis of arterial prosthetic graft infection by indium-111 oxine white blood cell scans. Circulation. 1982;66:130–4.Google Scholar
  53. 53.
    Love C, Palestro CJ. Radionuclide imaging of infection. J Nucl Med Technol. 2004;32:47–59.PubMedGoogle Scholar
  54. 54.
    Fukuchi K, Ishida Y, Higashi M, Tsunekawa T, Ogino H, Minatoya K, et al. Detection of aortic graft infection by fluorodeoxyglucose positron emission tomography: comparison with computed tomographic findings. J Vasc Surg. 2005;42:919–25.PubMedCrossRefGoogle Scholar
  55. 55.
    Tokuda Y, Oshima H, Araki Y, Narita Y, Mutsuga M, Kato K, et al. Detection of thoracic aortic prosthetic graft infection with 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Eur J Cardiothorac Surg. 2013;43:1183–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Keidar Z, Engel A, Hoffman A, Israel O, Nitecki S. Prosthetic vascular graft infection: the role of 18F-FDG PET/CT. J Nucl Med. 2007;48:1230–6.PubMedCrossRefGoogle Scholar
  57. 57.
    Bruggink JLM, Glaudemans AWJM, Saleem BR, Meerwaldt R, Alkefaji H, Prins TR, et al. Accuracy of FDG-PET-CT in the diagnostic work-up of vascular prosthetic graft infection. Eur J Vasc Endovasc Surg. 2010;40:348–54.PubMedCrossRefGoogle Scholar
  58. 58.
    Cook GJ, Fogelman I, Maisey MN. Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron-emission tomography scanning: potential for error in interpretation. Semin Nucl Med. 1996;26:308–14.PubMedCrossRefGoogle Scholar
  59. 59.
    Ruiz-Zafra J, Rodríguez-Fernández A, Sánchez-Palencia A, Cueto A. Surgical adhesive may cause false positives in integrated positron emission tomography and computed tomography after lung cancer resection. Eur J Cardiothorac Surg. 2013;43:1251–3.PubMedCrossRefGoogle Scholar
  60. 60.
    Bandyk DF. Antibiotics-why so many and when should we use them? Semin Vasc Surg. 2002;15:268–74.PubMedCrossRefGoogle Scholar
  61. 61.
    Bisdas T, Wilhelmi M, Haverich A, Teebken OE. Cryopreserved arterial homografts vs silver-coated Dacron grafts for abdominal aortic infections with intraoperative evidence of microorganisms. J Vasc Surg. 2011;53:1274–81.PubMedCrossRefGoogle Scholar
  62. 62.
    Zegelman M, Guenther G, Waliszewski M, Pukacki F, Stanisic MG, Piquet P, et al. Results from the International Silver Graft Registry for high-risk patients treated with a metallic-silver impregnated vascular graft. Vascular. 2013;21:137–47.PubMedCrossRefGoogle Scholar
  63. 63.
    Stewart AH, Eyers PS, Earnshaw JJ. Prevention of infection in peripheral arterial reconstruction: a systematic review and meta-analysis. J Vasc Surg. 2007;46:148–55.PubMedCrossRefGoogle Scholar
  64. 64.
    Kuehn C, Graf K, Mashaqi B, Pichlmaier M, Heuer W, Hilfiker A, et al. Prevention of early vascular graft infection using regional antibiotic release. J Surg Res. 2010;164:e185–91.PubMedCrossRefGoogle Scholar
  65. 65.
    Saleem BR, Meerwaldt R, Tielliu IFJ, Verhoeven ELG, van den Dungen JJAM, Zeebregts CJ. Conservative treatment of vascular prosthetic graft infection is associated with high mortality. Am J Surg. 2010;200:47–52.PubMedCrossRefGoogle Scholar
  66. 66.
    David TE, Gavra G, Feindel CM, Regesta T, Armstrong S, Maganti MD. Surgical treatment of active infective endocarditis: a continued challenge. J Thorac Cardiovasc Surg. 2007;133:144–9.PubMedCrossRefGoogle Scholar
  67. 67.
    Preventza O, Mohamed AS, Cooley DA, Rodriguez V, Bakaeen FG, Cornwell LD, et al. Homograft use in reoperative aortic root and proximal aortic surgery for endocarditis: a 12-year experience in high-risk patients. J Thorac Cardiovasc Surg. 2014;148:989–94.PubMedCrossRefGoogle Scholar
  68. 68.
    Lytle BW, Sabik JF, Blackstone EH, Svensson LG, Pettersson GB, Cosgrove DM. Reoperative cryopreserved root and ascending aorta replacement for acute aortic prosthetic valve endocarditis. Ann Thorac Surg. 2002;74:S1754–7.PubMedCrossRefGoogle Scholar
  69. 69.
    Bove EL, Parker FB, Marvasti MA, Randall PA. Complete extra-anatomic bypass of the aortic root: treatment of recurrent mediastinal infection. J Thorac Cardiovasc Surg. 1983;86:932–4.PubMedGoogle Scholar
  70. 70.
    Tsuji Y, Okita Y. Management of the aortic graft infection. Nihon Geka Gakkai Zasshi. 2002;103:856–60.PubMedGoogle Scholar
  71. 71.
    Hagl C, Galla JD, Lansman SL, Fink D, Bodian CA, Spielvogel D, et al. Replacing the ascending aorta and aortic valve for acute prosthetic valve endocarditis: is using prosthetic material contraindicated? Ann Thorac Surg. 2002;74:S1781–5.PubMedCrossRefGoogle Scholar
  72. 72.
    Ralph-Edwards A, David TE, Bos J. Infective endocarditis in patients who had replacement of the aortic root. Ann Thorac Surg. 1994;58:429–3.PubMedCrossRefGoogle Scholar
  73. 73.
    Raanani E, David TE, Dellgren G, Armstrong S, Ivanov J, Feindel CM. Redo aortic root replacement: experience with 31 patients. Ann Thorac Surg. 2001;71:1460–3.PubMedCrossRefGoogle Scholar
  74. 74.
    LeMaire SA, DiBardino DJ, Köksoy C, Coselli JS. Proximal aortic reoperations in patients with composite valve grafts. Ann Thorac Surg. 2002;74:S1777–80.PubMedCrossRefGoogle Scholar
  75. 75.
    Huh J, Chen JC, Furman GM, Malki C, King B, Kafie F, et al. Local treatment of prosthetic vascular graft infection with multivesicular liposome-encapsulated amikacin. J Surg Res. 1998;74:54–8.PubMedCrossRefGoogle Scholar
  76. 76.
    Kaya A, Schepens MA, Morshuis WJ, Heijmen RH, Brutel de la Riviere A, Dossche KM. Valve-related events after aortic root replacement with cryopreserved aortic homografts. Ann Thorac Surg. 2005;79:1491–5.PubMedCrossRefGoogle Scholar
  77. 77.
    Musci M, Weng Y, Hübler M, Amiri A, Pasic M, Kosky S, et al. Homograft aortic root replacement in native or prosthetic active infective endocarditis: twenty-year single-center experience. J Thorac Cardiovasc Surg. 2010;139:665–73.PubMedCrossRefGoogle Scholar
  78. 78.
    Solari S, Mastrobuoni S, De Kerchove L, Navarra E, Astarci P, Noirhomme P, et al. Over 20 years experience with aortic homograft in aortic valve replacement during acute infective endocarditis. Eur J Cardiothorac Surg. 2016;50:1158–64.PubMedCrossRefGoogle Scholar
  79. 79.
    Litzler PY, Thomas P, Danielou E, Lucq J, Jacques B, Frebourg N, et al. Bacterial resistance of refrigerated and cryopreserved aortic allografts in an experimental virulent infection model. J Vasc Surg. 1999;29:1090–6.PubMedCrossRefGoogle Scholar
  80. 80.
    Feingold B, Raval JS, Galambos C, Yazer M, Zeevi A, Bentlejewski C, et al. Tolerance to incompatible ABO blood group antigens is not observed following homograft implantation. Hum Immunol. 2011;72:835–40.PubMedPubMedCentralCrossRefGoogle Scholar
  81. 81.
    Vogt F, Böll BM, Boulesteix A-L, Kilian E, Santarpino G, Reichart B, et al. Homografts in aortic position: does blood group incompatibility have an impact on patient outcomes? Interact Cardiovasc Thorac Surg. 2013;16:619–24.PubMedPubMedCentralCrossRefGoogle Scholar
  82. 82.
    Abad C, Hurle A, Feijoo J, Gomez-Marrero J, Abdallah A. Total aortic arch replacement by a cryopreserved aortic homograft. Eur J Cardiothorac Surg. 1995;9:531–3.PubMedCrossRefGoogle Scholar
  83. 83.
    Moon MR, Miller DC, Moore KA, Oyer PE, Mitchell RS, Robbins RC, et al. Treatment of endocarditis with valve replacement: the question of tissue versus mechanical prosthesis. Ann Thorac Surg. 2001;71:1164–71.PubMedCrossRefGoogle Scholar
  84. 84.
    Leyh RG, Knobloch K, Hagl C, Ruhparwar A, Fischer S, Kofidis T, et al. Replacement of the aortic root for acute prosthetic valve endocarditis: prosthetic composite versus aortic allograft root replacement. J Thorac Cardiovasc Surg. 2004;127:1416–20.PubMedCrossRefGoogle Scholar
  85. 85.
    Kitamura S, Yagihara T, Kobayashi J, Nakajima H, Toda K, Fujita T, et al. Mid- to long-term outcomes of cardiovascular tissue replacements utilizing homografts harvested and stored at Japanese institutional tissue banks. Surg Today. 2011;41:500–9.PubMedCrossRefGoogle Scholar
  86. 86.
    Kieffer E, Gomes D, Chiche L, Fléron M-H, Koskas F, Bahnini A. Allograft replacement for infrarenal aortic graft infection: early and late results in 179 patients. J Vasc Surg. 2004;39:1009–17.PubMedCrossRefGoogle Scholar
  87. 87.
    Wilbring M, Sill B, Tugtekin SM, Alexiou K, Simonis G, Matschke K, et al. Transcatheter valve-in-valve implantation for deteriorated aortic bioprosthesis: initial clinical results and follow-up in a series of high-risk patients. Ann Thorac Surg. 2012;93:734–41.PubMedCrossRefGoogle Scholar
  88. 88.
    López-Otero D, Teles R, Gómez-Hospital JA, Balestrini CS, Romaguera R, Saaibi-Solano JF, et al. Transcatheter aortic valve implantation: safety and effectiveness of the treatment of degenerated aortic homograft. Rev Esp Cardiol. 2012;65:350–5.PubMedCrossRefGoogle Scholar
  89. 89.
    Otalvaro L, Alfonso CE, O’Neill WW, O’Neill BP, Heldman AW. Transfemoral aortic valve replacement in failing aortic root homografts. J Card Surg. 2014;29:333–6.PubMedCrossRefGoogle Scholar
  90. 90.
    Kubota H, Endo H, Noma M, Ishii H, Tsuchiya H, Yoshimoto A, et al. Xenopericardial roll graft replacement for infectious pseudoaneurysms and graft infections of the aorta. J Cardiothorac Surg. 2015;10:133.PubMedPubMedCentralCrossRefGoogle Scholar
  91. 91.
    Guenther SPW, Reichelt A, Peterss S, Luehr M, Bagaev E, Hagl C, et al. Root replacement for graft infection using an all-biologic xenopericardial conduit. J Heart Valve Dis. 2016;25:440–7.PubMedGoogle Scholar
  92. 92.
    Carrel TP, Berdat P, Englberger L, Eckstein F, Immer F, Seiler C, et al. Aortic root replacement with a new stentless aortic valve xenograft conduit: preliminary hemodynamic and clinical results. J Heart Valve Dis. 2003;12:752–7.PubMedGoogle Scholar
  93. 93.
    Siniawski H, Lehmkuhl H, Weng Y, Pasic M, Yankah C, Hoffmann M, et al. Stentless aortic valves as an alternative to homografts for valve replacement in active infective endocarditis complicated by ring abscess. Ann Thorac Surg. 2003;75:803–8.PubMedCrossRefGoogle Scholar
  94. 94.
    Lehmann S, Merk DR, Etz CD, Oberbach A, Uhlemann M, Emrich F, et al. Porcine xenograft for aortic, mitral and double valve replacement: long-term results of 2544 consecutive patients. Eur J Cardiothorac Surg. 2016;49:1150–6.PubMedCrossRefGoogle Scholar
  95. 95.
    Nakajima N, Masuda M, Ichinose M, Ando M. A new method for the treatment of graft infection in the thoracic aorta: in situ preservation. Ann Thorac Surg. 1999;67:1994–8.PubMedCrossRefGoogle Scholar
  96. 96.
    Seguin JR, Loisance DY. Omental transposition for closure of median sternotomy following severe mediastinal and vascular infection. Chest. 1985;88:684–6.PubMedCrossRefGoogle Scholar
  97. 97.
    Kawachi Y, Nakashima A, Onzuka T, Yamauchi T. False aneurysm of the ascending aorta concomitant with chronic mediastinitis after tube graft replacement in octogenarian. Eur J Cardiothorac Surg. 2002;22:450–3.PubMedCrossRefGoogle Scholar
  98. 98.
    Luehr M, Etz CD, Lehmkuhl L, Schmidt A, Misfeld M, Borger MA, et al. Surgical management of delayed retrograde type A aortic dissection following complete supra-aortic de-branching and stent-grafting of the transverse arch. Eur J Cardiothorac Surg. 2013;44:958–63.PubMedCrossRefGoogle Scholar
  99. 99.
    Czerny M, Weigang E, Sodeck G, Schmidli J, Antona C, Gelpi G, et al. Targeting landing zone 0 by total arch rerouting and TEVAR: midterm results of a transcontinental registry. Ann Thorac Surg. 2012;94:84–9.PubMedCrossRefGoogle Scholar
  100. 100.
    Tamura K, Yoshitaka H, Totsugawa T, Tsushima Y, Chikazawa G, Ohno T, et al. Bridge use of endovascular repair and delayed open operation for infected aneurysm of aortic arch. Ann Thorac Surg. 2013;96:1471–3.PubMedCrossRefGoogle Scholar
  101. 101.
    Shah S, Sinno S, Vandevender D, Schwartz J. Management of thoracic aortic graft infections with the omental flap. Ann Plast Surg. 2013;70:680–3.PubMedCrossRefGoogle Scholar
  102. 102.
    Miller DW, Johnson DD. Omental pedicle graft in the management of infected ascending aortic prostheses. Ann Thorac Surg. 1987;44:614–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Cardiac SurgeryUniversity Hospital, LMU MunichMunichGermany

Personalised recommendations