Outcomes of conservative treatment for thoracic vascular graft infections.

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 reoperative 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 centre. 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 [interquartile range (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.