BACKGROUND: The purpose of this study was to evaluate the short- and intermediate-term outcomes of open repair of mycotic @entity439 . Contemporary surgical and perioperative techniques were utilized. METHODS: From November 1997 to May 2014, 14 consecutive @entity1 underwent open repair of descending thoracic (n  = 9, 64.3%) and thoracoabdominal (n  = 5, 35.7%) mycotic @entity449 . All procedures were performed through the left side of the chest. Infected tissue was completely debrided and excised. Aortic continuity was restored in situ with a Dacron prosthesis (Macquet Corp, Oakland, NJ). Soft tissue coverage of the  prosthesis was performed when anatomy and @entity1  condition permitted. Perioperative outcomes, intermediate-term survival, and reinfection rates were examined. RESULTS: All @entity1 presented with either @entity439 or a clinical picture of @entity295 . Diagnosis was confirmed utilizing computed tomography imaging. Mean age was 66    13 years, 8 @entity1 (57.1%) were male, and mean @entity439 size was 5.9    1.3 cm. All @entity1 were @entity101 , 3 (21.4%) had prior coronary revascularization, 7 (50%) had @entity358 , 5 (35.7%) had @entity6 , and 2 (14.3%) had @entity454 requiring dialysis. Twelve @entity1 (85.7%) had @entity439 -related @entity158 , and 9 (64.3%) of them had contained @entity397 . Mean time from onset of illness to surgery was 36 days (range, 0 to 153). On preoperative blood cultures, 4 (28.6%) grew @entity794 , 4 (28.6%) grew gram negative organisms, 2 (14.3%) grew mycobacterium, and 4 cultures (28.6%) had negative results. Empiric broad-spectrum antibiotics were initiated on all @entity1 and adjusted based on final cultures. A  majority of @entity1 underwent repair utilizing a clamp-and-sew technique (n  = 10, 71.4%); the remainder (n  = 4, 28.6%) required repair under profound hypothermic @entity1167 . After radical debridement of the infected tissue, grafts were placed in the normal anatomic position; 6 (42.9%) @entity1 had additional soft tissue coverage, 5 (35.7%) utilizing an omental flap and 1  (7.1%), a serratus muscle flap. There was 1 in-hospital death (7.1%) secondary to @entity63 bowel. Four @entity1 (28.6%) required tracheostomy, and 1 (7.1%) had recurrent @entity128 . None of the @entity1 incurred @entity1566 , @entity64 , or new onset @entity177 requiring dialysis. After surgery, all @entity1 were given 6 weeks of intravenous antibiotics. Lifelong suppression therapy was maintained with oral antibiotics. There were no episodes of prosthetic graft infection on follow-up. Univariate  analysis revealed that New York Heart Association functional class, @entity6 , and preoperative @entity8 were preoperative risk factors for major adverse events. Mean follow-up time was 26.5 months (median 8.2; range, 1 to 142). Actuarial 5-year survival was  71%. CONCLUSIONS: Open repair of mycotic descending thoracic and @entity2334 remains the gold standard of therapy. Aggressive intraoperative debridement with in situ prosthetic reconstruction permits a high rate of success in this very high risk cohort of patients. Lifelong antibiotic suppression therapy may prevent late prosthetic graft infection.

Outcomes of Open Repair of Mycotic Descending Thoracic and XXXX .

@entity1 :: ('9606', 'Species') :: ['patient', 'patients'] @entity8 :: ('MESH:D007674', 'Disease') :: ['renal dysfunction'] @entity295 :: ('MESH:D018805', 'Disease') :: ['sepsis'] @entity449 :: ('MESH:D001014', 'Disease') :: ['aortic aneurysms'] @entity101 :: ('MESH:D006973', 'Disease') :: ['hypertensive'] @entity6 :: ('MESH:D003920', 'Disease') :: ['diabetes mellitus', 'diabetes'] @entity63 :: ('MESH:D007511', 'Disease') :: ['ischemic'] @entity64 :: ('MESH:D020521', 'Disease') :: ['stroke'] @entity794 :: ('1280', 'Species') :: ['Staphylococcus aureus'] @entity128 :: ('MESH:D020209', 'Disease') :: ['nerve injury'] @entity177 :: ('MESH:D051437', 'Disease') :: ['renal failure'] @entity2334 :: ('MESH:D017545', 'Disease') :: ['thoracoabdominal aortic aneurysms'] @entity439 :: ('MESH:D000783', 'Disease') :: ['thoracic and thoracoabdominal aneurysms', 'aneurysm', 'aneurysm-related symptoms'] @entity358 :: ('MESH:D008171', 'Disease') :: ['chronic pulmonary disease'] @entity397 :: ('MESH:D012421', 'Disease') :: ['rupture'] @entity158 :: ('MESH:D010146', 'Disease') :: ['pain'] @entity1167 :: ('MESH:D006323', 'Disease') :: ['circulatory arrest'] @entity1566 :: ('MESH:D013119', 'Disease') :: ['spinal cord injury'] @entity454 :: ('MESH:D007676', 'Disease') :: ['end-stage renal disease']
@entity2334 :: (MESH:D017545,Disease) :: ['Thoracoabdominal Aortic Aneurysms']
