Outcomes of conservative treatment for thoracic vascular graft infections

Abstract OBJECTIVES Thoracic vascular graft infections are devastating complications after aortic surgery, entailing high mortality. The gold standard treatment combines excisional surgery and antimicrobial therapy, but patients deemed inoperable might benefit from a conservative approach. Outcomes of patients treated only with antimicrobial agents without re-operative surgery are scanty. We aim to describe patients' characteristics and outcomes using an antibiotic-only strategy without thorough debridement. METHODS Retrospectively collected data from a prospective cohort in a tertiary center. Descriptive analysis for baseline characteristics and Kaplan–Meier estimates for survival were performed. RESULTS From November 2012 to December 2022, 66 patients were identified with aortic root, ascending aortic, and aortic arch graft infections. Of these, 44 received an antibiotic-only strategy or in combination with selective debridement after achieving multidisciplinary consensus. Median follow-up was 4.8 years (IQR 1.7–6.1), and cumulative survival was 82.9% (CI 95%, 69.7–96.1). Streptococcus spp were the most common isolated microorganisms. CONCLUSIONS In selected cases, a conservative approach with antibiotics only or in combination with selective debridement showed acceptable results at follow-up, suggesting a valuable therapy option for this cohort of patients.