Commentary: Recurrent xenopericardial elephant trunk graft infection: Snatching victory from the jaws of defeat
Notice bibliographique
Résumé
Central MessageLarge vegetation of a xenopericardial elephant trunk graft is an unusual cause of aortic obstruction.See Article page 46. Large vegetation of a xenopericardial elephant trunk graft is an unusual cause of aortic obstruction. See Article page 46. In this edition of the Journal, Minegishi and colleagues1Minegishi S. Inaba Y. Endo H. Kubota H. A large vegetation on a xenopericardial roll elephant trunk graft.J Thorac Cardiovasc Surg Tech. 2021; 6: 46-49Scopus (2) Google Scholar present a patient who underwent total arch replacement with elephant trunk for type A dissection. She developed an Enterobacter cloacae graft infection and underwent redo total arch replacement with xenopericardial roll graft. She then developed fungal infection of the elephant trunk with a near-occlusive vegetation and had redo-redo-descending aortic replacement via left chest. To our knowledge, this is the first report of a massive vegetation on an elephant trunk as a cause of near occlusion. That this surgical team successfully performed 3 high-risk operations is a tour de force and a tribute to the resilience of the surgical team and indeed the patient. Thoracic aortic prosthetic graft infection has an incidence of less than 3% but is associated with 25% to 75% mortality.2Tossios P. Karatzopoulos A. Tsagakis K. Sapalidis K. Grosomanidis V. Kalogera A. et al.Treatment of infected thoracic aortic prosthetic grafts with the in situ preservation strategy: a review of its history, surgical technique, and results.Heart Lung Circ. 2014; 23: 24-31Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar There is limited evidence to guide management, although some strategies include a combination of (1) reoperation with aggressive debridement and aortic replacement with a rifampin-soaked Dacron graft, homograft, or xenopericardial graft; (2) coverage with native tissue (eg, omental) flap; (3) local antibiotic infusion; (4) life-long suppressive antibiotics; and (5) wound drainage with or without negative-pressure dressings.3O'Connor S. Andrew P. Batt M. Becquemin J.P. A systematic review and meta-analysis of treatments for aortic graft infection.J Vasc Surg. 2006; 44: 38-45Abstract Full Text Full Text PDF PubMed Scopus (240) Google Scholar Familiarity with the range of therapeutic options, and flexibility in modifying the plan in the face of unanticipated challenges, is key. In the absence of robust evidence, guidelines for similar conditions can be instructive. The American Heart Association recommends that patients with fungal endocarditis receive parenteral antifungal therapy with amphotericin B plus an additional antifungal agent for a minimum of 6 weeks, followed by consideration of lifelong oral azole therapy.4Baddour L.M. Wilson W.R. Bayer A.S. Fowler Jr., V.G. Tleyjeh I.M. Rybak M.J. et al.Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association.Circulation. 2015; 132: 1435-1486Crossref PubMed Scopus (1258) Google Scholar Guidelines for intra-abdominal graft infections suggest the use of biologic over prosthetic material. They suggest use of arterial allografts over venous autografts due to the morbidity associated with vein harvest and wound healing, and suggest the use of rifampin- or silver-soaked synthetic grafts.3O'Connor S. Andrew P. Batt M. Becquemin J.P. A systematic review and meta-analysis of treatments for aortic graft infection.J Vasc Surg. 2006; 44: 38-45Abstract Full Text Full Text PDF PubMed Scopus (240) Google Scholar,5Wilson W.R. Bower T.C. Creager M.A. Amin-Hanjani S. O'Gara P.T. Lockhart P.B. et al.Vascular graft infections, mycotic aneurysms, and endovascular infections: a scientific statement from the American Heart Association.Circulation. 2016; 134: e412-e460Crossref PubMed Scopus (165) Google Scholar The basic principle of all infected prosthetic materials is source control with removal of all infected tissue and aggressive debridement. As always, a multidisciplinary team is recommended to include vascular and cardiothoracic surgeons, cardiologists, infectious diseases specialists, and radiologists, so that where evidence is lacking, clinical decision-making can benefit from broad expertise and collaboration. We thank the authors for sharing this rare presentation of graft occlusion by massive vegetation, and we congratulate the authors on their heroic and innovative surgical strategy which is instructive for those encountering similar challenging scenarios. A large vegetation on a xenopericardial roll elephant trunk graftJTCVS TechniquesVol. 6PreviewElephant trunk (ET) graft infection is a rare complication.1 We present the uncommon case of a large vegetation on an ET, which almost totally occluded the lumen during the late postoperative period. Full-Text PDF Open Access
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».