Pericardial Tube Grafts: Bail-out Option or Routine Concept for Thoracic Aortic Infections?

Objectives: Thoracic aortic infections are a deadly disease. Homografts are considered the gold standard to replace the affected aorta. However, availability is limited and long term results may be limited by homograft degeneration. Pericardial tube grafts have been suggested as an alternative. Biological valved pericardial conduits are commercially available. We reviewed our data on pericardial tube graft implantations.

Methods: Between 06/2014 and 08/2015 12 patients (age 60, range 40–74) underwent aortic repair with pericardial tube grafts. 5 patients received a biological valved pericardial conduit (BioIntegral) for aortic root and proximal aortic arch repair due to endocarditis after previous aortic root surgery. 2 patients underwent primary repair of an aortic valve endocarditis with root aneurysm. 2 patients underwent emergency operation due to mycotic aneurysms based on subacute aortic dissections and received a custom made pericardial tube graft for complete aortic arch repair in addition to a biological valved pericardial conduit. 2 patients underwent emergent descending aortic repair after stent graft infections with fistulae. One patient received a supracommissural and complete aortic arch repair.

Results: In hospital mortality was 25% (n = 3). One patient died of sudden cardiac death after aortic root and proximal aortic arch repair on POD9. One kidney transplant recipient with infected subacute aortic dissection Type Stanford A succumbed to postoperative septicemia. One patient suffered from aorto-esophageal fistula and aortic rupture after TEVAR and died in tabula. One patient was readmitted during follow up with a bronchopleural fistula due to pulmonary lacerations during initial pericardial tube graft repair of the descending aorta. 8 patients left the hospital in good condition after a median of 18 days (range 10–26) and are free of infection after a median follow up of 100 days (range 40–237).

Conclusions: Thoracic aortic infections are a lethal condition without surgical treatment. Under emergency conditions pericardial tube grafts are a valuable tool for aortic repair. Especially in combination with commercially available biological valved pericardial tube conduits, additional custom made pericardial tube grafts are a reasonable option for aortic root and aortic arch repair even in elective situations. Long term results have to be awaited to compare pericardial tube grafts and homografts.