Excellent outcomes with use of synthetic vascular grafts for treatment of mycotic aortic pseudoaneurysms after heart transplantation

Background: Mycotic pseudoaneurysm is a rare but potentially lethal complication after heart transplantation. Allograft has been advocated as the choice of material for aortic replacement. We report a series of 7 patients with pseudoaneurysm that was treated with primary repair or synthetic graft replacement.

Methods: Between October 2005 and February 2011, 8 patients (mean age, 55.3 years; range, 39 to 67 years), were diagnosed with mycotic pseudoaneurysms of the ascending aorta 2 to 29 months after transplantation. One patient declined operative repair, and the remainder had urgent or emergency surgical intervention. One patient had primary repair at the cardioplegia site, and one had primary end-to-end anastomosis after the infected recipient aortic segment was resected. Five patients had replacement of the infected aorta with a Dacron graft (DuPont, Wilmington, DE) for pseudoaneurysm development at the suture line or donor aorta. Clinical and radiologic follow-up assessments were performed in all patients.

Results: There were no operative or in-hospital deaths. None of the patients had major postoperative complications, and there was no cardiac allograft dysfunction. Median follow-up was 25 months (range, 1 to 48 months). One patient died of a pulmonary embolism 10 months after the operation. The remaining 6 patients remain free of infection. The most recent radiologic follow-up showed no residual or recurrence of pseudoaneurysms among the surviving patients.

Conclusions: A synthetic vascular graft to replace the infected aorta is a viable aortic substitute among transplant recipients, and in the presence of a vascularized flap, can offer excellent midterm outcomes.