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OBJECTIVES This report describes our experience with surgical management of aorta-related infections. METHODS From November 1999 to April 2013, 70 patients underwent surgical management for aorta-related infection, including aortobronchial fistula in 12 patients, aorto-oesophageal fistula in 14 and aortoduodenal fistula in 4. The location of infection was aortic root to arch in 22 patients, descending aorta in 29, thoraco-abdominal aorta in 12 and abdominal aorta in 7. Forty-seven patients had infections of the native aorta and 23 had postoperative graft infections. In situ replacement [bridge thoracic endovascular aortic repair (TEVAR); n = 1] was performed in 45 patients, endovascular aortic repair in 18 and extra-anatomical bypass (bridge TEVAR; n = 2) in 7. Omental flap was installed in 29 patients and a pedicled latissimus dorsi muscle flap was used in 3. Since 2008, we have been trying to resect not only the infected tissues, but also the surrounding aneurysmal wall as well. RESULTS Hospital mortality was 17.1% (12/70). Late death occurred in 15 patients. Overall survival at 3 years was 60.1 ± 6.7%. Freedom from infection-related death of patients who had in situ graft replacement, endovascular repair or extra-anatomical bypass at 3 years was 88.5 ± 4.9, 75.2 ± 10.9 or 14.3 ± 13.2%, respectively (P < 0.01). In situ graft replacement provided a better freedom from aortic event (recurrent infection and reintervention) at 3 years compared with endovascular repair (85.6 ± 5.5 vs 61.8 ± 12.5%, P = 0.029). Freedom from infection-related death at 3 years improved significantly from 61.1 ± 9.7 (before 2008) to 84.7 ± 5.8% (since 2008) (P = 0.044). CONCLUSIONS Surgical treatment for aorta-related infection is still associated with high mortality and morbidity. However, our current strategy, which is aggressive surgical management, including resection of infected tissues, extensive debridement, in situ graft replacement of the aorta and omental or muscle installation provided a better patient survival. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To present our experience of total aortic arch replacement through a left posterolateral thoracotomy. Methods: Sixteen patients (13 males; mean age 62.1±11.3 years) with extended thoracic aortic aneurysms, including those in the thoracoabdominal aorta, underwent replacement through a left posterolateral thoracotomy. The pathology of the diseased aorta was non-dissecting aneurysm due to aortitis in 1 patient and aortic dissection in 15 patients (acute type A: 1, chronic type A: 12, chronic type B: 2). In a prior operation, the patient with aortitis had undergone the Bentall procedure with endovascular stenting of the brachiocephalic artery, and among the other 15 patients, one previously had endovascular stenting for the aortic arch and 12 had hemi-arch replacement for acute type A dissection. Extension of arch replacement was the aortic arch and descending aorta in eight patients, the ascending arch and descending aorta in five patients and the descending arch, and thoracoabdominal aorta in three patients. Additional retroperitoneal dissection was required for the repair of a thoracoabdominal aortic aneurysm. Results: One patient died of traumatic cerebral hemorrhage on day 145 (hospital mortality 6.3%). Average duration of ventilation support was 19.4±17.0h and length of ICU stay was 3.6±1.6 days. Actuarial survival at 2 years after the operations was 67.7%. However, no aortic-related mortality was observed during follow-up. Conclusions: Early results of extended aortic arch replacement through a left posterolateral thoracotomy were satisfactory in selected patients. [Copyright &y& Elsevier]

Abstract: Objective: We investigated whether propofol, a widely used anesthetic, injected into clamped aortic segments quickly attenuated transcranial spinal motor-evoked potential (MEP) amplitudes and protected against spinal cord injury during thoracoabdominal aortic surgery. Methods: Eighteen beagle dogs were divided into three groups (n =6, each group): group 1 (20ml of saline, intra-aortic injection), group 2 (1.5mg/kg of propofol, intravenous injection), and group 3 (1.5mg/kg of propofol, intra-aortic injection). Aortic cross-clamping was performed for 30min. In each group, MEP amplitudes were recorded before, during, and after aortic cross-clamping. Tarlov score and histopathological examination were used to evaluate the protective effects of intra-aortic propofol injections. Results: MEP amplitudes in group 3 attenuated to a value that was 60% of the control in just a minute after aortic cross-clamping, but maintained 40% of the control value during aortic cross-clamping. However, MEP amplitudes in groups 1 and 2 gradually attenuated and almost disappeared. Groups 1 and 2 amplitudes were lower than those in group 3, 30min after aortic cross-clamping (p <0.001). Twenty-four hours after ischemia, the Tarlov score in group 3 was 3.5±0.5 and was higher than scores from groups 1 and 2, which were 0.5±0.5 and 1.3±1.2 (mean±SD, p <0.001, and p <0.001), respectively. Histopathologically, normal spinal cord motor neurons in group 3 were preserved to a significantly greater extent than in groups 1 and 2 (p =0.0031, and p =0.0282, respectively). There was a strong correlation between Tarlov scores at 24h and the number of normal motor neurons in the anterior horns of spinal cords (r =0.897; p <0.001). Conclusions: Intra-aortic propofol injections produce the quick suppression of MEP amplitudes and protect spinal cords from ischemia during aortic cross-clamping. [Copyright &y& Elsevier]