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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K, Siepe M, Estrera AL, Bavaria JE, Pacini D, Okita Y, Evangelista A, Harrington KB, Kachroo P, Hughes GC. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024; 118:5-115. [PMID: 38416090 DOI: 10.1016/j.athoracsur.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy; Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Texas
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany; The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| | - Matthias Siepe
- EACTS Review Coordinator; Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Anthony L Estrera
- STS Review Coordinator; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
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Grigorescu AE, Anghel A, Feier H. Successful Interventional Endovascular Management of Ruptured Penetrating Aortic Ulcer with Associated Enormous Right Pleural False Aneurysm. Clin Pract 2024; 14:619-628. [PMID: 38666807 PMCID: PMC11049587 DOI: 10.3390/clinpract14020049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/24/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Penetrating aortic injuries represent critical medical emergencies that necessitate immediate intervention to prevent life-threatening consequences. When accompanied by the presence of an enormous right pleural false aneurysm, the clinical scenario becomes exceptionally rare and complex. This case report details the successful management of a patient who presented with a penetrating aortic ulcer and an extensive false aneurysm within the right pleura, employing an interdisciplinary approach involving cardiac surgeons, cardiologists, interventional cardiologists, and radiologists. The pivotal intervention involved the deployment of a covered and bare stent graft into the descending thoracic aorta to seal the aortic rupture. The patient's clinical condition stabilized postoperatively, with no signs of recurrent hemorrhage. This case underscores the importance of rapid diagnosis, timely intervention, and the collaborative efforts of a specialized medical team in successfully managing such complex vascular injuries. Early recognition and referral to specialized centers are essential for improving patient outcomes in cases of penetrating aortic injuries with associated giant pseudoaneurysms.
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Affiliation(s)
- Andrei Emanuel Grigorescu
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (A.E.G.); (H.F.)
- Research Center of the Institute of Cardiovascular and Heart Disease of Timisoara, 300310 Timisoara, Romania
- Division of Cardiovascular Surgery, Institute for Cardiovascular Diseases, 300391 Timisoara, Romania
- Doctoral School Medicine—Pharmacy, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Andrei Anghel
- Department of Biochemistry, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Horea Feier
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (A.E.G.); (H.F.)
- Research Center of the Institute of Cardiovascular and Heart Disease of Timisoara, 300310 Timisoara, Romania
- Division of Cardiovascular Surgery, Institute for Cardiovascular Diseases, 300391 Timisoara, Romania
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3
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg 2024; 65:ezad426. [PMID: 38408364 DOI: 10.1093/ejcts/ezad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, TX, USA
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany
- The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
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Frankel WC, Green SY, Amarasekara HS, Orozco-Sevilla V, Preventza O, LeMaire SA, Coselli JS. Early and late outcomes of surgical repair of mycotic aortic aneurysms: A 30-year experience. J Thorac Cardiovasc Surg 2024; 167:578-587. [PMID: 35643768 DOI: 10.1016/j.jtcvs.2022.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 02/17/2022] [Accepted: 03/16/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Mycotic aortic aneurysm and its associated complications are often catastrophic. In this study, we examined the early and late outcomes of surgical repair of mycotic aortic aneurysm at our center over the last 3 decades. METHODS We retrospectively reviewed our prospectively maintained aortic surgery database with supplemental adjudication of medical records. Aortic infection was confirmed through clinical, radiological, intraoperative, pathological, and treatment evidence. RESULTS Seventy-five patients (median age, 68 years; interquartile range, 62-74) who underwent surgical repair of a mycotic aortic aneurysm between 1992 and 2021 were included. Almost all patients (n = 72; 96%) presented with symptoms, including 26 patients (35%) with rupture, and many underwent urgent or emergency repair (n = 64; 85%). Sixty-one patients underwent open repair, and 14 patients underwent hybrid or endovascular repair. Infection-specific adjunct techniques included rifampin-soaked grafts (n = 16), omental pedicle flaps (n = 21), and antibiotic irrigation catheters (n = 8). There were 15 early deaths (20%), including 10 of the 26 patients (38%) who presented with rupture; however, persistent stroke, paraplegia or paraparesis, and renal failure necessitating dialysis were uncommon (each <5%). Almost all early survivors (52/60; 87%) were discharged with long-term antibiotic therapy. Estimated survival at 2, 6, and 10 years was 55.7% ± 5.8%, 39.0% ± 5.7%, and 26.9% ± 5.5%, respectively. CONCLUSIONS A substantial proportion of patients with mycotic aortic aneurysm present with rupture and generally require urgent or emergency repair. Operative mortality and complications are common, especially for patients who present with rupture, and late survival is poor.
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Affiliation(s)
- William C Frankel
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Susan Y Green
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Hiruni S Amarasekara
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Vicente Orozco-Sevilla
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Tex.
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Tex
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Mestres C, Van Hemelrijck M, Quintana E, Smit FE. Significance and current approaches to vascular graft infection. Indian J Thorac Cardiovasc Surg 2023; 39:333-340. [PMID: 38093914 PMCID: PMC10713901 DOI: 10.1007/s12055-023-01638-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 12/17/2023] Open
Abstract
Vascular graft/endograft infection (VGEI) is a constant in cardiovascular surgery with published rates between 1 and 5%. Every graft type and anatomical location is a potential target for infectious complications. These patients are sick patients with high frailty burden. Management of VGEI entails a multidisciplinary and multimodality approach. Here we review some aspects of the problem of VGEI including prevention, diagnosis, and surgical therapy with focus on recent developments in the field.
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Affiliation(s)
- Carlos–Alberto Mestres
- Department of Cardiothoracic Surgery, Faculty of Health Sciences and The Robert WM Frater Cardiovascular Research Centre, The University of the Free State, PO Box 339 (Internal Box G32), Bloemfontein, 9300 South Africa
| | | | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Francis Edwin Smit
- Department of Cardiothoracic Surgery, Faculty of Health Sciences and The Robert WM Frater Cardiovascular Research Centre, The University of the Free State, PO Box 339 (Internal Box G32), Bloemfontein, 9300 South Africa
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6
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Godefroy W, Faivre L, Sansac C, Thierry B, Allain JM, Bruneval P, Agniel R, Kellouche S, Monasson O, Peroni E, Jarraya M, Setterblad N, Braik M, Even B, Cheverry S, Domet T, Albanese P, Larghero J, Cattan P, Arakelian L. Development and qualification of clinical grade decellularized and cryopreserved human esophagi. Sci Rep 2023; 13:18283. [PMID: 37880340 PMCID: PMC10600094 DOI: 10.1038/s41598-023-45610-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/21/2023] [Indexed: 10/27/2023] Open
Abstract
Tissue engineering is a promising alternative to current full thickness circumferential esophageal replacement methods. The aim of our study was to develop a clinical grade Decellularized Human Esophagus (DHE) for future clinical applications. After decontamination, human esophagi from deceased donors were placed in a bioreactor and decellularized with sodium dodecyl sulfate (SDS) and ethylendiaminetetraacetic acid (EDTA) for 3 days. The esophagi were then rinsed in sterile water and SDS was eliminated by filtration on an activated charcoal cartridge for 3 days. DNA was removed by a 3-hour incubation with DNase. A cryopreservation protocol was evaluated at the end of the process to create a DHE cryobank. The decellularization was efficient as no cells and nuclei were observed in the DHE. Sterility of the esophagi was obtained at the end of the process. The general structure of the DHE was preserved according to immunohistochemical and scanning electron microscopy images. SDS was efficiently removed, confirmed by a colorimetric dosage, lack of cytotoxicity on Balb/3T3 cells and mesenchymal stromal cell long term culture. Furthermore, DHE did not induce lymphocyte proliferation in-vitro. The cryopreservation protocol was safe and did not affect the tissue, preserving the biomechanical properties of the DHE. Our decellularization protocol allowed to develop the first clinical grade human decellularized and cryopreserved esophagus.
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Affiliation(s)
- William Godefroy
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital Saint-Louis - Université Paris Cité, Paris, France.
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France.
- CIC de Biothérapies CBT 501, Paris, France.
- Human Immunology, Pathophysiology, Immunotherapy / HIPI / INSERM UMR976, Laboratoire de Biotechnologies de Cellules Souches, Université Paris Cité, 75010, Paris, France.
| | - Lionel Faivre
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France
- CIC de Biothérapies CBT 501, Paris, France
- Human Immunology, Pathophysiology, Immunotherapy / HIPI / INSERM UMR976, Laboratoire de Biotechnologies de Cellules Souches, Université Paris Cité, 75010, Paris, France
| | - Caroline Sansac
- Banque de Tissus Humains, Hôpital St-Louis, AP-HP, Paris, France
| | - Briac Thierry
- Human Immunology, Pathophysiology, Immunotherapy / HIPI / INSERM UMR976, Laboratoire de Biotechnologies de Cellules Souches, Université Paris Cité, 75010, Paris, France
- Service d'ORL Pédiatrique, AP-HP, Hôpital Universitaire Necker, 75015, Paris, France
| | - Jean-Marc Allain
- LMS, CNRS, Ecole Polytechnique, Institut Polytechnique de Paris, Palaiseau, France
- Inria, Paris, France
| | - Patrick Bruneval
- Service d'Anatomie Pathologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Rémy Agniel
- Equipe de Recherche sur les Relations Matrice Extracellulaire-Cellules, ERRMECe (EA1391), Institut des Matériaux, I-MAT (FD4122), CY Cergy Paris Université, Cergy-Pontoise, France
| | - Sabrina Kellouche
- Equipe de Recherche sur les Relations Matrice Extracellulaire-Cellules, ERRMECe (EA1391), Institut des Matériaux, I-MAT (FD4122), CY Cergy Paris Université, Cergy-Pontoise, France
| | - Olivier Monasson
- CNRS, BioCIS, CY Cergy Paris Université, 95000, Cergy Pontoise, France
- CNRS, BioCIS, Université Paris-Saclay, 92290, Châtenay-Malabry, France
| | - Elisa Peroni
- CNRS, BioCIS, CY Cergy Paris Université, 95000, Cergy Pontoise, France
- CNRS, BioCIS, Université Paris-Saclay, 92290, Châtenay-Malabry, France
| | - Mohamed Jarraya
- Banque de Tissus Humains, Hôpital St-Louis, AP-HP, Paris, France
| | - Niclas Setterblad
- UMS Saint-Louis US53 / UAR2030, Institut de Recherche Saint-Louis Plateforme Technologique Centre, Université Paris Cité - Inserm - CNRS, Paris, France
| | - Massymissa Braik
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Benjamin Even
- Laboratoire Gly-CRRET, Université Paris Est Créteil, Université Paris Est, EA 4397 ERL CNRS 9215, Créteil, France
| | - Sophie Cheverry
- Laboratoire Gly-CRRET, Université Paris Est Créteil, Université Paris Est, EA 4397 ERL CNRS 9215, Créteil, France
| | - Thomas Domet
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France
- CIC de Biothérapies CBT 501, Paris, France
| | - Patricia Albanese
- Laboratoire Gly-CRRET, Université Paris Est Créteil, Université Paris Est, EA 4397 ERL CNRS 9215, Créteil, France
| | - Jérôme Larghero
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France
- CIC de Biothérapies CBT 501, Paris, France
- Human Immunology, Pathophysiology, Immunotherapy / HIPI / INSERM UMR976, Laboratoire de Biotechnologies de Cellules Souches, Université Paris Cité, 75010, Paris, France
- Centre MEARY de Thérapie Cellulaire Et Génique, AP-HP, Hôpital Saint-Louis, 75010, Paris, France
| | - Pierre Cattan
- Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Hôpital Saint-Louis - Université Paris Cité, Paris, France
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France
- CIC de Biothérapies CBT 501, Paris, France
- Human Immunology, Pathophysiology, Immunotherapy / HIPI / INSERM UMR976, Laboratoire de Biotechnologies de Cellules Souches, Université Paris Cité, 75010, Paris, France
| | - Lousineh Arakelian
- Unité de Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France.
- CIC de Biothérapies CBT 501, Paris, France.
- Human Immunology, Pathophysiology, Immunotherapy / HIPI / INSERM UMR976, Laboratoire de Biotechnologies de Cellules Souches, Université Paris Cité, 75010, Paris, France.
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Kumins NH, Wogsland AA, Smith J, Patel A, Cho JS, Colvard B, Kashyap VS. Management and Outcome of Non-Aneurysmal Primary Aortic Infection. Vasc Endovascular Surg 2023; 57:222-229. [PMID: 36453193 DOI: 10.1177/15385744221143659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Aortic infection without prior intervention or aneurysm is exceedingly rare. We report the presentation, diagnosis, management, and outcome of patients with this unusual entity. METHODS Retrospective chart and imaging review of patients with primary aortic infection. RESULTS 5 patients (3 male, mean age 71.2 years) presented between 2014 and 2022. All had abdominal, back, or flank pain. Four had constitutional symptoms. All were evaluated with a complete blood count; 3 had leukocytosis. Both serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were elevated in the 4 patients evaluated with these tests. All were studied with peripheral blood culture on the first hospital day prior to any antibiotic administration. Blood culture was positive in only 1 patient. Computed tomography (CT) scan showed periaortic inflammation without aneurysm in all. Fluorodeoxyglucose positron emission tomography (PET) was obtained in 3 and a radiolabeled leukocyte single-photon emission CT (SPECT) scan was performed in 2. All demonstrated periaortic concentration of the radioisotope consistent with inflammation or infection. Intraoperative cultures were positive in 3. One patient who had a negative intraoperative culture was examined with broad range polymerase chain reaction (PCR) and DNA sequencing which identified a causative bacterium. The other patient with a negative intraoperative culture had periaortic abscess but was on antibiotics preoperatively, potentially confounding the culture. All patients underwent in-situ repair with rifampin impregnated polyester (N = 2), cryopreserved aortic allograft (N = 2), or autogenous femoral vein (N = 1). No patient developed recurrent infection or aortic related complications following surgery with an average follow up of 31.8 months (range 8-88 months). CONCLUSIONS Patients with primary aortic infection present similarly with the triad of abdominal or back pain, laboratory markers of infection, and imaging demonstrating periaortic inflammation. Patients were treated successfully with in-situ repair. Preoperative identification of a causative organism was difficult, and PCR may be useful to help identify an organism.
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Affiliation(s)
- Norman H Kumins
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart and Vascular Institute, 24575University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Aric A Wogsland
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart and Vascular Institute, 24575University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Justin Smith
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart and Vascular Institute, 24575University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Avkash Patel
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart and Vascular Institute, 24575University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart and Vascular Institute, 24575University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Benjamin Colvard
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart and Vascular Institute, 24575University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Harrington Heart and Vascular Institute, 24575University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Voit A, Commander SJ, Anjorin AC, Williams Z. Outcomes Following in Situ Reconstruction for Aortic Infection with the Neo-Aortoiliac System and Aortic Homograft. Ann Vasc Surg 2023; 90:93-99. [PMID: 36374744 DOI: 10.1016/j.avsg.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND In situ reconstruction is one of the primary surgical options for primary aortic and graft and endograft infections. One institution's outcomes following aortic reconstruction with femoro-popliteal vein (i.e., the neo-aortoiliac system) and cryopreserved aortic allografts are described. METHODS A retrospective review was performed of any patient who underwent aortic reconstruction with femoropopliteal vein or cryopreserved aortic allograft from 2013-2022 at a single tertiary-care institution. RESULTS Twenty four patients underwent in situ reconstruction with the neo-aortoiliac system or with cadaveric allograft for primary or secondary aortic infection from 2013-2022. Short-term (30-day) mortality remains low (3/24 or 12.5%) despite the high incidence of major postoperative complications that necessitated reintervention in 11/24 or 45.8% of the cohort, most often for recurrent intracavitary infection. Gram-negative and drug-resistant pathogens were the most commonly implicated organisms in recurrent intra-abdominal infection. Management of early allograft degeneration is also described with extra-anatomic bypass grafting, conduit/graft embolization, which is then followed by allograft explantation and wide surgical debridement. Despite low short-term (30-day) mortality, all-cause 1-year mortality remains elevated at 38.1% (8/21) in those with an adequate follow-up interval. CONCLUSIONS In situ reconstruction for primary or secondary aortic infections results in excellent short-term patient outcomes but is characterized by a high incidence of reintervention and an elevated all-cause 1-year mortality.
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Affiliation(s)
- Antanina Voit
- Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC.
| | - Sarah Jane Commander
- Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC
| | - Aderike C Anjorin
- Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC
| | - Zachary Williams
- Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC
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9
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Infection of Vascular Prostheses: A Comprehensive Review. PROSTHESIS 2023. [DOI: 10.3390/prosthesis5010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Vascular graft or endograft infection (VGEI) is a complex disease that complicates vascular-surgery and endovascular-surgery procedures and determines high morbidity and mortality. This review article provides the most updated general evidence on the pathogenesis, prevention, diagnosis, and treatment of VGEI. Several microorganisms are involved in VGEI development, but the most frequent one, responsible for over 75% of infections, is Staphylococcus aureus. Specific clinical, surgical, radiologic, and laboratory criteria are pivotal for the diagnosis of VGEI. Surgery and antimicrobial therapy are cornerstones in treatment for most patients with VGEI. For patients unfit for surgery, alternative treatment is available to improve the clinical course of VGEI.
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10
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Corniquet M, Khalifé M, Lellouch AG, Bel A, Bellenfant F, Julia P, Alsac JM, El Batti S, Ben Abdallah I. Ruptured infective native thoracic aortic aneurysm treated by endovascular repair as a bridge therapy to open repair. JOURNAL DE MEDECINE VASCULAIRE 2023; 48:36-40. [PMID: 37120270 DOI: 10.1016/j.jdmv.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/14/2023] [Indexed: 05/01/2023]
Abstract
We report the case of a 70-year-old woman who presented with a ruptured infective native thoracic aortic aneurysm (INTAA), associated with spondylodiscitis and posterior mediastinitis. She underwent a staged hybrid repair: urgent thoracic endovascular aortic repair was first performed as a bridge therapy in the context of septic shock. Allograft repair using cardiopulmonary bypass was performed five days later. Given the complexity of INTAA, multidisciplinary teamwork was paramount to determine the most appropriate treatment strategy, including procedure planning with multiple operators as well as perioperative care. Therapeutic alternatives are discussed.
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Affiliation(s)
- M Corniquet
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France; Inserm, UMR S 1140, Fondation Alain Carpentier, Laboratoire de Recherches Biochirugicales, 75015 Paris, France.
| | - M Khalifé
- Department of orthopedic surgery, HEGP, Université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - A G Lellouch
- Department of plastic surgery, HEGP, Université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - A Bel
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France; Inserm, UMR S 1140, Fondation Alain Carpentier, Laboratoire de Recherches Biochirugicales, 75015 Paris, France.
| | - F Bellenfant
- Department of anesthesiology and critical care, HEGP, Université Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris, France.
| | - P Julia
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France.
| | - J-M Alsac
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France; Inserm, UMR S 1140, Fondation Alain Carpentier, Laboratoire de Recherches Biochirugicales, 75015 Paris, France.
| | - S El Batti
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France; Inserm, UMR S 1140, Fondation Alain Carpentier, Laboratoire de Recherches Biochirugicales, 75015 Paris, France.
| | - I Ben Abdallah
- Department of cardiovascular surgery, Hôpital Européen Georges-Pompidou (HEGP), Université Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 20, rue Leblanc, 75015 Paris, France; Inserm, UMR S 1140, Fondation Alain Carpentier, Laboratoire de Recherches Biochirugicales, 75015 Paris, France.
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Golemovic M, Skific M, Haluzan D, Pavic P, Golubic Cepulic B. Ten-year experience with cryopreserved vascular allografts in the Croatian Cardiovascular Tissue Bank. Cell Tissue Bank 2022; 23:807-824. [PMID: 35129755 PMCID: PMC8818844 DOI: 10.1007/s10561-022-09992-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
Abstract
The Croatian Cardiovascular Tissue Bank (CTB) was established in June 2011. Activities managed by CTB are processing of heart valves and blood vessels, as well as quality control, storage, medical release and distribution of allografts. The aim of this report is to present CTB's vascular tissue activities and retrospectively evaluate the outcomes of their use in the University Hospital Centre Zagreb. Between June 2011 and July 2021, 90 vascular allografts (VAs) from 55 donors after brain death were referred to CTB. Only 54% of VAs met the tissue quality requirements while 46% of tissues were discarded. The most frequent reasons for discard were unacceptable morphology and initial microbiological contamination. Altogether 42 VAs were released for transplantation and 37 of them were used in 27 surgical procedures. The most common indication for surgery was prosthetic graft or stent infection. According to the anatomic position of vascular reconstruction, patients were divided in the aortic and peripheral reconstruction group. A total of 23 patients were treated. In the aortic reconstruction group 58% of patients did not experience any graft-related complications. In the group of patients who underwent peripheral reconstruction significant incidence of reinfection was observed highlighting it as a major graft-related complication. Despite the small patient groups and limited duration of follow-up, presented clinical outcomes provide valuable information on the efficacy of vascular allografts. Additional clinical results collected on a larger patient groups and comparison to other reconstructive treatment options are necessary.
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Affiliation(s)
- M Golemovic
- Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - M Skific
- Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - D Haluzan
- Department of Surgery, Division for Vascular Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - P Pavic
- Department of Surgery, Division for Vascular Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - B Golubic Cepulic
- Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
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Wang Z, Li C, Quan Q, Zhang Y. Study on Risk Factors and Nutritional Status of Postoperative Infection in Patients Undergoing Abdominal Surgery. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8063851. [PMID: 35935330 PMCID: PMC9325349 DOI: 10.1155/2022/8063851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/16/2022] [Accepted: 06/25/2022] [Indexed: 11/18/2022]
Abstract
In order to evaluate the risk factors of postoperative infection in patients undergoing abdominal surgery and the correlation with nutritional status, 143 patients admitted to our hospital for abdominal surgery from September 2020 to September 2021 are selected and analyzed. By collecting the clinical results and related pathological data of all patients, all patients are divided into the postoperative infection group (48 cases) and the noninfection group (95 cases) according to whether postoperative infection occurred. Firstly, the clinical data of the two groups are analyzed by univariate analysis. Secondly, the risk factors of postoperative infection in patients undergoing abdominal surgery are analyzed by binary logistic regression. Thirdly, the nutrition-related indexes are compared, and the correlation between postoperative infection and serum nutritional indexes is analyzed by the Spearman correlation coefficient. The results demonstrate that patients undergoing abdominal surgery have a certain risk of infection after surgery, and combination with underlying diseases is a risk factor for postoperative infection. In addition, poor preoperative nutritional status is also closely related to postoperative infection. It is suggested that serum PA and RBP indicators have certain predictive effects on postoperative infection.
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Affiliation(s)
- Zhejin Wang
- Department of Hepatobiliary Surgery, Wenzhou Central Hospital, The Second Affiliated Hospital of Shanghai University, Wenzhou 325000, China
| | - Chen Li
- Department of Hepatobiliary Surgery, Wenzhou Central Hospital, The Second Affiliated Hospital of Shanghai University, Wenzhou 325000, China
| | - Qi Quan
- Department of Hepatobiliary Surgery, Wenzhou Central Hospital, The Second Affiliated Hospital of Shanghai University, Wenzhou 325000, China
| | - Ying Zhang
- Department of Clinical Laboratory, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Shanghai University, Wenzhou 325000, China
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13
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Capturing the Complexity of Open Abdominal Aortic Surgery in the Endovascular Era. J Vasc Surg 2022; 76:1520-1526. [PMID: 35714893 DOI: 10.1016/j.jvs.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/24/2022] [Accepted: 06/03/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Volume and quality benchmarks for open abdominal aortic surgery and particularly open aortic aneurysm repair (OAR) in the endovascular era are guided by the Society for Vascular Surgery (SVS) guidelines, but the Vascular Quality Initiative (VQI) OAR module fails to capture the full spectrum of complex OAR. We hypothesized that VQI-ineligible complex OAR is the dominant form of open repairs performed at a VQI-participating tertiary center. METHODS All OAR cases performed at a single tertiary care center from 2007 to 2020 were reviewed. The VQI OAR criteria were applied with exclusions (non-VQI) defined as concomitant renal bypass, clamping above the superior mesenteric artery (SMA) or celiac artery, repairs performed for trauma, anastomotic aneurysm, isolated iliac aneurysm, or infected aneurysms. Linear regression was used to assess temporal trends. RESULTS Among a total of 481 open abdominal aortic operations, 355 (74%) were OAR. The average annual OAR volume remained stable over 14 years (25 ± 6; P = .46). Non-VQI OAR comprised 54% of all cases and persisted over time (R2 = .047, P = .46). Supra-celiac clamping (35%) was often necessary. The proportion of endograft explantation cases significantly increased over time from 4% in 2007 to 20% in 2019 (P = .01). Infectious indications represented 20% (n = 70) of cases. Visceral branch grafts were performed in 16% of all cases. OAR for ruptured aneurysm constituted 10% of cases. Thirty-day mortality was significantly higher in non-VQI vs. VQI-eligible OAR cases (10% vs. 4%; P = .04). CONCLUSIONS Complex OAR comprises a majority of OAR cases in a contemporary tertiary referral hospital, yet these cases are not accounted for in the VQI. Creation of a "complex OAR" VQI module would capture these cases in a quality-driven national registry and help to better inform benchmarks for volume and outcomes in aortic surgery.
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