Mediastinal transposition of the greater omentum for treatment of infected prostheses of the ascending aorta and aortic arch.

OBJECTIVES: The aim of this study was to evaluate the outcomes of transposition of the omentum into the mediastinum to support the replacement of infected aortic grafts or to cover infected aortic grafts that are not amenable for surgical replacement. METHODS: All patients with thoracic aortic graft infections who underwent mediastinal transposition of the omentum at our institution between 2005 and 2023 were included in this study. Mediastinal transposition of the omentum was performed either after replacement of the infected graft ('curative concept') or solely as bailout procedure by wrapping the infected graft ('palliative concept'). The diagnosis, including computed tomography scans during follow-up, was made according to the criteria of the Management of Aortic Graft Infection Collaboration. RESULTS: The patient cohort consisted of 31 patients. Both in-hospital and 1-year mortality were 0% (n = 0) for the curative concept (n = 9) compared to 23% (n = 5) and 41% (n = 9) for the palliative concept (n = 22), respectively. There was no graft infection-associated death or recurrence of infection after 3 years in the curative group. Survival was 52% at 3 years in the palliative group, with freedom of infection in 59% of the patients (n = 13). CONCLUSIONS: Transposition of the omentum and wrapping of the infected aortic prosthetic graft is a useful bailout strategy for patients who are ineligible for replacement of an infected aortic graft. However, mortality stays high. For radical treatment of aortic graft infections, it may prove an effective supportive therapy and represents an important tool in the armamentarium of cardiac surgeons.

Migration of Amplatzer Septal Occluder to the Deep Aortic Arch in a Patient With Multiple Anatomic Anomalies.

Atrial septal defect closure using the Amplatzer septal occluder (AGA Medical Corp, Golden Valley, MN) device is an established treatment option with excellent clinical outcome. However, several structural characteristics have been reported to be prognostic factors for failure of catheter interventional treatment. We report successful surgical removal of an Amplatzer septal occluder that had become dislocated and had migrated into the deep aortic arch. Compatible with previous reports, the patient presented with an atrial septal defect complicated by multiple anatomic deformities that were considered to be a contraindication for interventional treatment. Detailed structural assessment of the atrial septal defect is mandatory for successful treatment using the Amplatzer septal occluder.

Initial experience with abdominal aneurysm repair using the E-vita abdominal stent-graft: a single-center study.

PURPOSE: To evaluate the feasibility and midterm results of a new stent-graft for infrarenal endovascular aneurysm repair (EVAR) in a non-selected population. METHODS: Nineteen consecutive patients (19 men; mean age 70 years, range 58-87) who presented within an 8-month period with abdominal aortic aneurysms (AAA) suitable for EVAR were treated with the new E-vita abdominal stent-graft. Most of the patients (13, 68%) were ASA grade 3 or higher; the maximum AAA diameter was 57 mm (40-75), and hostile necks were present in a third and tortuous iliac arteries in half. Most of the cases (18, 95%) were elective; 1 was performed for a contained rupture. Seventeen procedures were primary implantations and 2 were secondary repairs of failing endografts. RESULTS: All stent-grafts were implanted at the intended position; no conversions to open surgery were necessary and no type I endoleak was noted. Fifteen bifurcated and 4 straight stent-grafts were implanted; the majority of the vascular accesses (29/35, 83%) were percutaneous. There was no 30-day mortality. In the mean 10-month follow-up (range 4-17), no stent fractures, migrations, or secondary endoleaks were noted. Aneurysm diameter was reduced in 8 (42%) and remained unchanged in 11 (58%) patients. One patient required open surgery at 1 year for thrombotic occlusion of the stent-graft. Two octogenarian patients died during follow-up. CONCLUSION: The E-vita abdominal stent-graft appears safe and effective in this initial midterm clinical experience. This device appears especially suitable to challenging aneurysm anatomy, such as severely angulated necks or tortuous and dilated iliac arteries.