Commentary: The next quarter century

Central MessageThe excellent surgical results obtained in the treatment of thoracic aortic graft infections is less fully realized with endografts. This significant face expanding TEVAR indications.See Article page 1. The indications. See In this edition Journal, Nissen and colleagues1Nissen A.P. Sandhu H.K. Mashtaq H. Miller III, C.C. Safi H.J. Estrera A.L. et al.Resection replacement infections.J Thorac Cardiovasc Surg. 2021; 162: 1-8Abstract Full Text PDF Scopus (4) Google Scholar report on nearly a quarter century's experience management infections. Of interest year which study period ended; 2013 was US Food Drug Administration added acute chronic type B dissection as indications for use Conformable GORE TAG Thoracic Endoprosthesis (W.L. Gore Associates, Inc, Flagstaff, Ariz). It also that Nienaber associates2Nienaber C.A. Kische S. Rousseau Eggebrecht Rehders T.C. Kundt G. al.INSTEAD-XL trialEndovascular repair dissection: long-term randomized Investigation Stent Grafts Aortic Dissection trial.Circ Interv. 2013; 6: 407-416Crossref PubMed (627) published 5-year Extended Length Follow-up (INSTEAD-XL) trial, showing elective endovascular (TEVAR) uncomplicated dissections had superior outcomes compared to best medical therapy alone all-cause mortality, aorta-specific disease progression. Just few months later, Bavaria colleagues3Bavaria J.E. Brinkman W.T. Hughes G.C. Khoynezhad A. Szeto W.Y. Azizzadeh al.Outcomes from Valiant United States Investigational Device Exemption Study.Ann 2015; 100 (discussion 808-9): 802-808Abstract (53) presented findings DISSECTION trial complicated dissections, rapidly followed by approval Captivia System (Medtronic Minneapolis Minn) dissections. Although predates these landmark events, may be most imminent wave patients who will undergo or aneurysmal degeneration. entire cohort, 30-day mortality infection very respectable 9.4%, despite more than one-third having fistulization. Comparison cohort without undergoing reoperations showed similar overall reinfection-free survivals. These are likely due aggressive treatment, mean time 4 5 days admission intervention 75% vascularized tissue coverage, factor associated 0%. One group, however, did not benefit such results. Among endograft infection, universally fatal, 0% survival at 2.5 months. cite advanced age concomitant fistulization potential confounders, albeit representing small proportion (12.5%), one surgeons should pay heed. Examination existing literature helpful but limited. INSTEAD-XL none early late aorta-related events (death additional open surgery) were related infectious etiologies (C. Nienaber, personal communication, November 11, 2019). population highly selected, only 23% those screened enrolled into study. observational studies, coworkers4Szeto Desai N.D. Moeller P. Moser G.W. Woo E.Y. Fairman R.M. al.Reintervention failures after repair.J 145: S165-S170Abstract (36) reported rate reintervention endografts 11.7%, 3.75% complications. institution incidence (both abdominal thoracic) 0.6%, notable increase hospital transfers problem latter half study.5Murphy E.H. Herdrich B.J. Jackson B.M. Wang G.J. al.The following aneurysm Vasc 58: 1179-1185Abstract (74) 6 infections, deemed have inoperable managed conservatively; other 2, underwent explantation, 1 survived 24.7 months' follow-up. Notably, studies before expansion another experienced center. As undergoes implementation beyond clinical conditions an pool operators, University Pennsylvania group serve cautionary tale. special consideration blunt trauma. addition lack good quality registry data loss follow-up characterize trauma population, coexisting injuries (such splenic injury requiring splenectomy resulting hyposplenism) emergency urgent nature risk infection. For all disease, condition remains lifelong risk, even treatment. we move new benefit, keep mind signal raised article colleagues.1Nissen Resection infectionsThe Journal Cardiovascular SurgeryVol. 162Issue 1PreviewThoracic (TAGI) presents formidable challenge high mortality. We evaluated our 22-year managing TAGI extensive debridement, replacement, antibiotics. Full-Text