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Biomedical subjects

C Antona

Publications and source records attributed to C Antona.

At least 19 recordsLinked to original sources
PubMed2001

Myocardial revascularization with multiple arterial grafts: comparison between the radial artery and the right internal thoracic artery.

BACKGROUND: Bilateral internal thoracic artery (ITA) harvesting is significantly underused, whereas the radial artery is being used with increasing frequency. We have retrospectively analyzed perioperative and short-term outcomes of patients receiving a radial artery versus those receiving a right ITA as a second arterial graft. METHODS: Between February 1999 and May 2000, 250 patients underwent coronary artery bypass grafting using the radial artery (156 patients) or the right ITA (94 patients) in combination with the left ITA and, when required, the saphenous vein. RESULTS: There was a higher prevalence of risk factors in the radial artery group. More coronary artery bypass graftings (p < 0.001) were performed with the radial artery. Operative mortality was not different (p = not significant). In the right ITA group there was more bleeding (p < 0.001) and a longer hospital stay (p < 0.001). Mean follow-up was 8.1 +/- 3.9 months. The probability of survival was similar (p = not significant). CONCLUSIONS: The radial artery can extend the benefits of multiple arterial grafting to those patients who are usually excluded from bilateral ITA harvesting because of multiple risk factors. Perioperative and short-term results are good.

Adult↗
PubMed2001

Shifting the biotransformation pathways of L-phenylalanine into benzaldehyde by Trametes suaveolens CBS 334.85 using HP20 resin.

AIMS: The biotransformation of L-phenylalanine into benzaldehyde (bitter almond aroma) was studied in the strain Trametes suaveolens CBS 334.85. METHODS AND RESULTS: Cultures of this fungus were carried out in the absence or in the presence of HP20 resin, a highly selective adsorbent for aromatic compounds. For the identification of the main catabolic pathways of L-phenylalanine, a control medium (without L-phenylalanine) was supplemented with each of the aromatic compounds, previously detected in the culture broth, as precursors. Trametes suaveolens CBS 334.85 was shown to biosynthesize benzyl and p-hydroxybenzyl derivatives, particularly benzaldehyde, and large amounts of 3-phenyl-1-propanol, benzyl and p-hydroxybenzyl alcohols as the products of both cinnamate and phenylpyruvate pathways. CONCLUSION: The addition of HP20 resin, made it possible to direct the catabolism of L- phenylalanine to benzaldehyde, the desired target compound, and to trap it before its transformation into benzyl alcohol. In these conditions, benzaldehyde production was increased 21-fold, from 33 to 710 mg l-1 corresponding to a molar yield of 31%. SIGNIFICANCE AND IMPACT OF THE STUDY: These results showed the good potential of Trametes suaveolens as a biotechnological agent to synthesize natural benzaldehyde which is one of the most important aromatic aldehydes used in the flavour industry.

Benzaldehydes↗
PubMed2001

Increased phospholipid transfer protein activity in Aspergillus oryzae grown on various industrial phospholipid sources.

The effect of industrial carbon sources on phospholipid transfer protein production was investigated. Phospholipid fractions of different composition were prepared from various plant oils (i.e., soybean, rapeseed, and sunflower) according to the Lucas Meyer extraction and purification process. The effect of these fractions on phospholipid transfer protein activity of cell extracts from Aspergillus oryzae grown on medium containing these phospholipids as sole carbon source was studied. It was shown that phospholipid transfer activity was markedly increased by extracts containing a particular phospholipid composition. However, this stimulation depends mainly upon the phospholipid composition of the fraction used as fermentation substrate. Fractions enriched mainly in phosphatidylinositol (Epikuron 110), at the expense of phosphatidylcholine, were the most efficient sources for phospholipid transfer protein production by A. oryzae. Maximal phospholipid transfer activity, as well as biomass production, were increased 4.1- and 9.7-fold, respectively, when cultures were supplemented with Epikuron 110 prepared from sunflower lecithin, as compared to glucose-control cultures.

Aspergillus oryzae↗
PubMed2001

Transesophageal echocardiography as predictor of mitral valve repair.

BACKGROUND AND AIM OF THE STUDY: Mitral valve repair has recently emerged as the treatment of choice in patients presenting with insufficiency due to valve prolapse. The study aims were to evaluate: (i) the clinical presentation in a consecutive series of patients with mitral valve prolapse undergoing surgical repair; (ii) the correlation between pre- and intraoperative echocardiographic features and surgical findings in these patients; and (iii) whether clinical and echocardiographic data may predict surgical outcome. METHODS: Between March 1997 and May 2000, 152 patients (110 men, 42 women; mean age 59+/-13 years) were recruited into the study. All patients had myxomatous mitral valve disease causing severe regurgitation and underwent systematic examination by transesophageal echocardiography (TEE) for clear delineation of the three scallops of the posterior leaflet and juxtaposed segments of the anterior leaflet. RESULTS: In 119 patients (78%) a flail valve was documented by TEE and confirmed on surgical inspection; an anterior leaflet chordal rupture was not visualized by TEE in one case. In 15 cases (10%) there was flail of the anterior leaflet, and in 105 cases (69%) flail of the posterior leaflet. A bileaflet complex prolapse without chordal rupture was found in 32 cases. On the basis of TEE evaluation, mitral valve replacement was performed electively in 10 patients (7%); the other 142 (93%) underwent mitral valve repair. Adequate repair was obtained in 93% of cases; residual mitral regurgitation (eight cases; grade 3+) and mitral stenosis (one case) were documented by intraoperative TEE, and nine patients (6%) underwent valve replacement. CONCLUSION: The majority of patients with myxomatous mitral valve prolapse and severe regurgitation undergoing valve repair have chordal rupture of the posterior mitral leaflet, a condition in which results of valve repair are excellent. TEE provides a powerful means to define the mechanisms of mitral regurgitation and to identify the suitability of patients for valvuloplasty.

Adult↗
PubMed2000

Use of a new diagnostic catheter for transradial internal mammary artery angiography early after minimally invasive coronary bypass.

We describe a new diagnostic catheter specifically designed for selective catheterization of the left internal mammary artery via the ipsilateral radial approach. We used this catheter to assess the patency of the distal mammary-left anterior descending coronary artery anastomosis in 30 consecutive patients early after minimally invasive direct coronary artery bypass grafting. The new catheter design allowed easy and fast engagement of the left internal mammary artery leading to optimal vessel opacification in all cases. Angiography revealed graft problems in seven (23.3%) patients, two of whom required anastomosis revision, surgical in one case and with PTCA in the other. No LIMA injury occurred as a result of selective catheterization. Patients with functionally normal anastomosis were discharged on the same day of the diagnostic procedure.

Aged↗
PubMed2000

Minimally invasive direct coronary artery bypass grafting: midterm results and quality of life.

BACKGROUND: There is increasing interest in minimally invasive direct coronary artery bypass grafting (MID-CABG); however, there is still little information about midterm results and postoperative quality of life. METHODS: From March 1995 to March 1998, 64 patients underwent MIDCABG at our hospital. Their mean age was 60+/-9.5 years; 22 (34.4%) had unstable angina. All patients were followed-up by both direct visit and questionnaire to assess the postoperative quality of life. RESULTS: There were no perioperative deaths nor conversions to sternotomy; the perioperative myocardial infarction rate was 1/64 (1.6%). Predischarge angiography showed overall and unobstructed patency rates of 96.8% (62 of 64) and 93.8% (60 of 64), respectively. At follow-up (25+/-11.4 months) actuarial survival was 100%, and survival free of myocardial infarction was 98.4%+/-1.6% at 3 years. Both the Physical Activity Score and the Psychological General Well-being Index improved significantly after the operation, with percentage improvements of 31% and 23%, respectively, at 12 months postoperatively. CONCLUSIONS: In selected patients MIDCABG can be a reliable and safe option. Patients who undergo this procedure are free of major complications and enjoy a good quality of life after surgery.

Aged↗
PubMed2000

[Right pleural effusion in aortic dissecting aneurysm].

Right hemorrhagic pleural effusion may be a presenting sign of thoracic aortic dissecting aneurysm. We describe 2 cases of massive right hemorrhagic pleural effusion and dissection of the descending aorta (type B) detected at tomographic scan. Transesophageal echocardiography ruled out a retrograde dissection of the ascending aorta. Right hemorrhagic pleural effusion is an unusual clinical presentation in thoracic aorta dissection and, up to now, the underling pathophysiology of this sign has not been defined yet.

Aortic Dissection↗
PubMed1999

Nonembolic predictors of stroke risk in coronary artery bypass patients.

The aim of this study was to identify and stratify the most important nonembolic risk factors for stroke after coronary bypass grafting. From June 1994 to June 1997 a series of 1532 patients (pts) underwent isolated myocardial revascularization on cardiopulmonary bypass (CPB). A retrospective chart review selected 1417 pts in whom the presence of aortic calcification or left ventricular mural thrombi was not detectable by echocardiogram, angiogram, and intraoperative records. Univariate and multivariate analyses were conducted to identify nonembolic variables independently correlated to postoperative stroke. A predictive model of stroke probability was then constructed by means of a mathematic method with the variables selected from logistic regression analyses. The global incidence of stroke was 1.8%. Univariate analysis revealed that, among 29 preoperative and operative variables, age, vasculopathy, emergency operation, previous cerebrovascular accident (CVA), CPB, and aortic cross-clamping times were factors strongly associated with postoperative stroke (p < 0.01). A first logistic regression analysis (LRA) selected as independent predicting variables (p < 0.05) age [odds ratio (OR) 1.07/year], vasculopathy (OR 4), previous CVA (OR 7.2), CPB time (OR 1/year), and emergency operation (OR 4.2). In a second stepwise LRA, age and CPB time were subdivided into cohorts as follows: age </= 65 years, > 65 but < 75 years, >/= 75 years; CPB time </= 120 minutes, > 120 but < 180 minutes, >/= 180 minutes. Both age >/= 75 years (p = 0.024; OR 3.3) and CPB time >/= 180 minutes (p = 0.002; OR 4.2), were found to be predictors of postoperative neurologic damage. Finally, a probability table of stroke risk was obtained with the logistic regression coefficients. A lower stroke probability (0.7%) was calculated in the absence of risk variables and a higher one in the presence of all of them (83.3%). Between these extremes, a total of 158 combinations of stroke probabilities were obtained. We concluded that previous CVA, vasculopathy, emergency operation, and age > 75 years are variously associated with a high risk of nonembolic stroke after myocardial revascularization. A duration of CPB longer than 3 hours strongly increases the probability of neurologic damage in the presence of the aforementioned variables.

Age Factors↗
PubMed1999

[Coronary surgery without extracorporeal circulation: the short-term results in high-risk patients].

BACKGROUND: This study was conducted to assess the impact of coronary bypass surgery (CABG) without cardiopulmonary bypass (CPB) on high-risk patients. METHODS: From February 1997 to July 1998, 71 patients considered at high-risk underwent a CABG off-pump. Using the "Higgins score", eleven preoperative risk factors were identified and stratified in this group of patients. Among 1271 patients who underwent CABG with CPB in the same period, using a computer-based matched comparison, a second identical group of patients was selected according to the 11 risk variables and the number with coronary disease, so that complete preoperative matching included the year of operation, score index and coronary target. Moreover, among seven other preoperative variables that were not included in the matching comparison, the two groups differed only in mean age (64 +/- 10.9 vs 61.6 +/- 7.3 in groups off and on-pump, respectively, p < 0.05). Postoperative outcome and complications and blood requirement were compared. Myocardial cell injury and left ventricular performance were also assessed in the two groups. RESULTS: The global incidence of neurologic complications in the off-pump group was significantly lower (9.8 vs 0%, in on and off-pump groups, respectively; p = 0.02). Patients undergoing CABG off-pump required blood far less often (% of transfused patients: 26.7% for the patients with CPB and 11.2% for the patients without CPB; p = 0.032). Three patients from the on-pump group (4.2%) had a perioperative myocardial infarction (AMI), versus 0% of the off-pump cases (p = ns). Postoperative atrial fibrillation accounted for 14.1% in off-pump patients and 30.9% in on-pump patients (p = 0.027). One patient in both groups (1.4%) suffered from postoperative heart failure. Mean ventilation time and ICU stay did not differ significantly between the two groups. However, hospital discharge occurred earlier in the off-pump group (9.3 +/- 3 vs 12.6 +/- 8, p = 0.007). In-hospital death occurred in one case from the on-pump group (1.4%) versus 0% of patients operated off-pump. CPK-MB release in patients without perioperative AMI was significantly lower in off-pump patients 6 and 12 hours after the operation (36.6 +/- 17 IU/l vs 69.8 +/- 23 IU/l after 6 hours, p < 0.05; and 36.7 +/- 19 IU/l vs 67.3 +/- 26 IU/l after 12 hours, p < 0.05, in off and on-pump groups, respectively) and LVSWI turned out to be better in off-pump patients 6 hours postoperatively (34.2 +/- 2 g*m/m2 vs 27.2 +/- 3 g*m/m2, p < 0.01). CONCLUSIONS: CABG without CPB seems to be a promising technique for high-risk patients. It offers better neurologic and cardiac protection, shortens postoperative hospital stay and reduces the need for blood transfusion.

Aged↗
PubMed1998

Video-assisted minimally invasive coronary bypass surgery without cardiopulmonary bypass.

BACKGROUND: There is a growing interest in cardiac surgery towards minimally invasive approach to coronary bypass operations without cardiopulmonary bypass. PATIENTS AND METHODS: From March 1995 to March 1997, 41 patients underwent a single left internal mammary artery (LIMA) to the left anterior descending artery (LAD) coronary grafting without cardiopulmonary bypass through a small left anterior thoracotomy (MIDCABG). The mean age was 61.2+/-8.7 years (range 43-77 years), 28 patients. were male (68.2%) and the redo rate was 4.8% (2/41). In all patients the coronary artery disease involved the LAD, which was occluded in seven patients (17.1%). Thirty-eight patients (96.2%) selected for MIDCABG had a monovascular disease on LAD not suitable for percutaneous coronary angioplasty; two (4.8%) a bivascular disease, and one (2.4%) a trivascular disease. Skin incision was performed in the 4th anterior intercostal space from the left parasternal line for a 10.5 cm length on average. The LIMA harvesting was partially video-assisted by thoracoscopy. RESULTS: The LAD temporary occlusion was achieved with two double 5/0 polypropilene round-LAD sutures. The mean LAD ischemic time was 22+/-8 min (range 4-35 min). No thoracotomy procedure was changed into a sternotomy approach. We had one (2.4%) perioperative AMI; two patients (4.8%) were reoperated for bleeding. All patients underwent a postoperative angiographic reinvestigation within 1 month after surgery. All anastomoses were perfectly patent but two (4.8%). One patient was reoperated via a sternotomy access recycling the LIMA graft, the other one underwent successful PTCA. All patients also underwent an early and mid-term (6 months after surgery) echo-Doppler study of the LIMA flow and patency. At follow-up, performed at a mean of 8.7 months (range 1-23) after discharge, all patients were alive; no one experienced recurrence of angina. All patients also performed a mid-term negative treadmill stress test. CONCLUSIONS: MIDCABG is, in selected patients, reliable and safe, and offers encouraging early and mid-term clinical results.

Cardiopulmonary Bypass↗
PubMed1997

Hypertonicity induces injury to cultured human endothelium: attenuation by glutamine.

BACKGROUND: Although most preservation solutions as well as some cardioplegic solutions used for organ storage and transplantation are hypertonic, the effects of extracellular hypertonicity on endothelium are not well established. Aims of this study were to evaluate the response of cultured human saphenous vein endothelial cells to extracellular hypertonicity and to investigate the role of the amino acid glutamine in preventing endothelial damage in vitro. METHODS: Eight distinct strains of human saphenous vein endothelial cells were studied. Hypertonic (350 and 400 mosm/kg) media were obtained by supplementing culture medium with sucrose. Cell viability was assessed in the absence or the presence of glutamine through the determination of cell number and protein content of the cultures. Confocal microscopy of cells loaded with the fluorescent dye calcein was also performed. RESULTS: Exposure of human saphenous vein endothelial cells to hypertonic media without glutamine caused significant cell loss within 30 minutes. Cell loss progressed steadily during incubation and after 6 hours reached 50% at 350 mosm/kg and 65% at 400 mosm/kg. In the presence of 2 mmol/L glutamine, endothelial damage was completely prevented at 350 mosm/kg and significantly lessened at 400 mosm/kg compared with glutamine-free media. Confocal microscopy showed that most hypertonicity-treated cells exhibited the typical features of an apoptotic death and confirmed the osmoprotective effect of glutamine. CONCLUSIONS: These results indicate that the supplementation of hypertonic storage solutions with glutamine might exert a partial osmoprotective effect and suggest that the relationship between endothelial damage and tonicity of storage and cardioplegic solutions should be carefully investigated.

Aged↗
PubMed1997

Non-invasive evaluation of right gastroepiploic artery with colour Doppler echography.

The right gastroepiploic artery has been increasingly used as a coronary bypass graft. Short- and mid-term patency rates support the supposition that the right gastroepiploic artery is a satisfactory bypass conduit. However, conclusive angiographic data on long-term patency rates are still lacking. An echo-colour Doppler method was used to detect patency of the right gastroepiploic artery grafts through an upper abdominal approach. A group of 24 patients with a right gastroepiploic artery graft to the right or posterior descending coronary artery, all of whom also had a postoperative angiographic study which showed 100% patency of the graft were used as a reference group. A second group of 89 patients was also investigated only with echo-colour Doppler during the postoperative period (mean 8.0 (range 1-48) months). A patent right gastroepiploic artery graft showed a biphasic velocity pattern. Systolic peak velocity ranged from 8 to 26 cm and diastolic peak velocity from 4 to 13 cm. The right gastroepiploic artery diameter ranged from 1.7 to 2.4 mm and flow from 10.2 to 58.8 ml. Among the second group were three patients who had, at their echo-colour Doppler examination, a possible occlusion of the right gastroepiploic artery graft; an angiographic study was conducted and the graft closure confirmed in all cases. Serial echo-colour Doppler evaluation of the right gastroepiploic artery blood flow pattern and diameter is a non-invasive and safe method to check the patency and flow capacity of the artery graft in follow-up studies.

Adult↗
PubMed1997

Aprotinin and deep hypothermic circulatory arrest: there are no benefits even when appropriate amounts of heparin are given.

OBJECTIVE: To evaluate retrospectively the effect of 'high-dose' aprotinin on blood losses, donor blood requirements and morbid events on patients undergoing ascending aorta and/or aortic arch procedures with the employ of deep hypothermic circulatory arrest (HCA). METHODS: During the period 1987-1994, 39 patients underwent a thoracic aorta procedure with the employ of circulatory arrest; of these 18 (46.2%) were operated on during the period 1990-1994 and were given aprotinin intraoperatively following the 'high-dose' protocol (group I), while 21 (53.8%) who underwent surgery during the years 1987-1989, did not receive intraoperative aprotinin and served as historical controls (group II). Twenty-seven (69.2%) patients were male, 18 (46.2%) were operated on on an emergency basis, 15 (38.5%) were acute type A dissections, and two (5.1%) were redo-operations. Circulatory arrest times were not significantly different between the two groups (40 +/- 4 (S.E.) group I vs. 43 +/- 4 min group II, P = 0.62) likewise cardiopulmonary bypass (CPB) times (181 +/- 9 vs. 201 +/- 20 mm, P = 0.74) and the amount of heparin administered (32056 +/- 1435 vs. 31 691 +/- 1935 IU, P = 0.56). RESULTS: Postoperative blood loss was comparable between the two groups (1213 +/- 243 (median 850) group I vs. 1528 +/- 377 (median 880) ml group II, P = 0.87), as well as the number of units of donor blood transfused (9.4 +/- 3.0 (median 6) vs. 9.9 +/- 3.6, (median 5) P = 0.87), and revisions for bleeding (2/18, 11.1% vs. 3/21, 14.3%, P = 0.77). In-hospital mortality rate was not statistically different (5/18, 27.7% group I vs. 6/21, 28.6% group II, P = 0.92). There were no significant differences between the two groups in myocardial infarction (2/18, 11.1% vs. 0/21, 0%, P = 0.21), and postoperative renal failure rates (3/18, 16.7% vs. 2/21, 9.5%, P = 0.65). On the other hand, there was a trend towards an increased incidence of permanent neurological deficit (5/18, 27.7% group I vs. 1/21, 4.8% group II, P = 0.07) and towards a more complicated postoperative course (perioperative renal failure and/or myocardial infarction and/or neurological deficit either transient or permanent) (8/18, 44.4% group I vs. 4/21, 19% group II, P = 0.09) in group I patients. Forward stepwise logistic regression analysis, performed on the whole group of patients, identified chronic obstructive pulmonary disease (P = 0.010, Odds ratio (OR) = 5.7), aprotinin use (P = 0.017, OR = 5.1), and the number of units of blood collected intraoperatively by the cellsaver (P = 0.045, OR = 1.3/unit) as independent predictors of complicated postoperative course in the whole group of patients. CPB time (P = 0.040, OR = 1.032/min), circulatory arrest time (P = 0.053, OR = 1.22/min), and overall donor blood units transfused (P = 0.067, OR = 1.37/unit) emerged as independent risk factors for in-hospital mortality at multivariate analysis. CONCLUSIONS: Even when appropriate amounts of heparin are administered, 'high-dose' aprotinin probably is not an effective blood-sparing drug in deep HCA. Aprotinin should be employed cautiously in this clinical setting because of its possible correlation with an increased rate of postoperative morbid events.

Aged↗
PubMed1997

Mid-term follow-up of 183 arterial myocardial revascularization procedures.

OBJECTIVE: To evaluate the mid-term results of complete arterial myocardial revascularization performed with arterial conduits. METHODS: From July 1987 to December 1994, 183 patients underwent a myocardial revascularization procedure with the use of at least two arterial grafts (IMAs, rGEA, IEA) at our institute. Their mean age was 56 +/- 8.7 years, the redo-operation rate was 16.9% (31/183), two-vessel disease was present in 61 patients (33.3%), three-vessel disease in 122 (66.7%). RESULTS: The LIMA was used in 179 patients (97.8%), the RIMA in 116 (63.4%), the rGEA in 66 (36.1%) and the IEA in 41 (22.4%). In-hospital mortality was 1.1% (2/183), while the perioperative myocardial infarction (MI) rate was 2.2% (4/183). The angiographic restudy, performed on 87 (47.5%) patients during the early postoperative period (median 38 days) showed the following grafts patency rates: LIMA 98.8 (86/87), RIMA 97.1 (34/35), IEA 85.7 (24/28), rGEA 97.05 (33/34) and saphenous vein 90.9% (10/11). The median follow-up was 35 months. Kaplan-Meier survival was 96 +/- 2% at 3 and 5 years, freedom from angina 94 +/- 2% at 3 years and 91 +/- 3% at 5 years, while the Kaplan-Meier freedom from cardiac events was 90 +/- 3% at 3 years and 88 +/- 3% at 5 years. Cox regression analysis identified perioperative MI (P = 0.03, relative risk 3.6) as the only prognostic factor for mortality at follow-up. With regards to recurrence of angina, multivariate analysis has shown that incremental risk factors for the return of angina are redo-operation (P < 0.01, relative risk 2.7) and the persistence of hypertension after surgery (P < 0.01; relative risk 3.2), while the use of the RIMA in the operation has emerged as a protective factor (P = 0.02; relative risk 0.43). Finally, only redo-operation (P < 0.01; relative risk 2.3), has emerged as a predictor of cardiac complications. CONCLUSION: Myocardial revascularization with at least two arterial grafts can be performed with very low perioperative morbidity and mortality and good mid-term follow-up. The mid-term results of arterial myocardial revascularization are less favourable in cases of redo-operations or when the RIMA is not used.

Actuarial Analysis↗
PubMed1997

Treatment of chronic hepatitis C with interferon-alpha by monitoring the response according to viraemia.

In chronic hepatitis C (HCV) infection, treatment with interferon is associated with a rather low rate of sustained response and many treated patients do not achieve significant benefit. Efforts have therefore been made to identify non-responders as early as possible to avoid unjustified costs and side-effects. We treated 106 cases of HCV with an algorithm based on the results of sequential alanine aminotransferase (ALT) and HCV RNA determinations, using an initial dose of 6 MU thrice weekly for 4 months, and modified the subsequent treatment according to the biochemical and virological profile. Thirty-three out of 48 patients (68.7%) who were HCV RNA negative with normal ALT at 4 months after initiation of treatment were sustained responders when treated for an additional 4-month period with a reduced 3 MU dose, while sustained response was achieved in 12.5% of HCV RNA positive patients treated with a higher dosage and for a more prolonged period of time. Our findings indicate that HCV RNA monitoring during interferon therapy may be useful in modifying of the treatment schedule for the individual patient.

Adolescent↗
PubMed1997

[Surgical therapy for prosthetic infections of the thoracic aorta. Conservative approach].

The prosthetic graft infection of the thoracic aorta is a dreaded complication and it is associated with a high mortality rate. There is not substantial agreement in literature about how to manage a vascular graft infection, except for local anti-septic irrigation with a systemic antibiotic therapy. The main point of discussion is if it is mandatory to remove or not the infected thoracic aorta prosthesis: some authors prefer to eliminate all the thoracic aortic prostheses which may be infected, while others propose graft removal only when the sutures lines are involved. In this paper we report our experience on the conservative management of infected thoracic aorta prostheses using a local antiseptic irrigation, a perigraft debridement and leaving the original graft "in situ" when there is evidence of graft damage especially or involvement of the sutures lines. This approach has been performed in three patients: two had an infected aortic arch prosthesis, while one had a descending thoracic aorta prosthesis infection.

Aorta, Thoracic↗