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. 2025 Jun 3;67(6):ezaf171.
doi: 10.1093/ejcts/ezaf171.

Outcomes of conservative treatment for thoracic vascular graft infections

Mathias Van Hemelrijck  1 , Juri Sromicki  1 , Petar Risteski  1 , Rasha Boulos  1 , Ronny R Buechel  2 , Michelle Frank  3 , Barbara Hasse  4 , Héctor Rodríguez Cetina Biefer  1   5 , Omer Dzemali  1   5 ; VASGRA Cohort
Collaborators, Affiliations

Outcomes of conservative treatment for thoracic vascular graft infections

Mathias Van Hemelrijck et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: 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.

Methods: Retrospectively collected data from a prospective cohort in a tertiary centre. Descriptive analysis for baseline characteristics and Kaplan-Meier estimates for survival were performed.

Results: 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.

Conclusions: 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.

Keywords: Antimicrobial treatment; Endocarditis team; Thoracic vascular graft infection.

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Figures

None
Graphical abstract
Figure 1:
Figure 1:
Kaplan–Meier survival estimates.
Figure 2:
Figure 2:
Re-intervention analysis during follow-up with death as a competing event.
Figure 3:
Figure 3:
Reinfection analysis during follow-up with death as a competing event.
See this image and copyright information in PMC

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