{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T21:09:55Z","timestamp":1784063395915,"version":"3.55.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T00:00:00Z","timestamp":1748476800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","doi-asserted-by":"publisher","award":["#32003B_219351\/1"],"award-info":[{"award-number":["#32003B_219351\/1"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>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\u2019 characteristics and outcomes using an antibiotic-only strategy without thorough debridement.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Retrospectively collected data from a prospective cohort in a tertiary centre. Descriptive analysis for baseline characteristics and Kaplan\u2013Meier estimates for survival were performed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>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\u2009years [interquartile range (IQR) 1.7\u20136.1], and cumulative survival was 82.9% (CI 95%, 69.7\u201396.1). Streptococcus spp were the most common isolated microorganisms.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf171","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T11:03:37Z","timestamp":1748516617000},"source":"Crossref","is-referenced-by-count":6,"title":["Outcomes of conservative treatment for thoracic vascular graft infections"],"prefix":"10.1093","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0191-757X","authenticated-orcid":false,"given":"Mathias","family":"Van Hemelrijck","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Zurich , Zurich,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9964-7733","authenticated-orcid":false,"given":"Juri","family":"Sromicki","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Zurich , Zurich,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6979-5057","authenticated-orcid":false,"given":"Petar","family":"Risteski","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Zurich , Zurich,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasha","family":"Boulos","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Zurich , Zurich,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8064-8904","authenticated-orcid":false,"given":"Ronny R","family":"Buechel","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich , Zurich,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Frank","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Zurich , Zurich,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7196-3734","authenticated-orcid":false,"given":"Barbara","family":"Hasse","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich , Zurich,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5855-8993","authenticated-orcid":false,"given":"H\u00e9ctor","family":"Rodr\u00edguez Cetina Biefer","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Zurich , Zurich,","place":["Switzerland"]},{"name":"Center for Translational and Experimental Cardiology (CTEC), University of Zurich , Zurich,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7910-5152","authenticated-orcid":false,"given":"Omer","family":"Dzemali","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Zurich , Zurich,","place":["Switzerland"]},{"name":"Center for Translational and Experimental Cardiology (CTEC), University of Zurich , Zurich,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"VASGRA Cohort","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Hasse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Ledergerber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Reutersberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelies S","family":"Zinkernagel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Zimmermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,5,29]]},"reference":[{"key":"2025060915514434300_ezaf171-B1","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/S0003-4975(01)03336-7","article-title":"Aortic root replacement in 271 Marfan patients: a 24-year experience","volume":"73","author":"Gott","year":"2002","journal-title":"Ann Thorac Surg"},{"key":"2025060915514434300_ezaf171-B2","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/0003-4975(94)92221-7","article-title":"Infective endocarditis in patients who had replacement of the aortic root","volume":"58","author":"Ralph-Edwards","year":"1994","journal-title":"Ann Thorac Surg"},{"key":"2025060915514434300_ezaf171-B3","doi-asserted-by":"crossref","first-page":"304","DOI":"10.5761\/atcs.oa.13-00059","article-title":"Treatment of prosthetic graft infection after thoracic aorta replacement","volume":"20","author":"Takano","year":"2014","journal-title":"Ann Thorac Cardiovasc Surg"},{"key":"2025060915514434300_ezaf171-B4","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1093\/icvts\/ivv024","article-title":"Prosthetic vascular graft infection through a median sternotomy: a multicentre review dagger","volume":"20","author":"Oda","year":"2015","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2025060915514434300_ezaf171-B5","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/00000658-196308000-00014","article-title":"Clinical experience with management of the infected Dacron graft","volume":"158","author":"Carter","year":"1963","journal-title":"Ann Surg"},{"key":"2025060915514434300_ezaf171-B6","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.ejvs.2019.10.016","article-title":"Editor\u2019s choice\u2014European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of vascular graft and endograft infections","volume":"59","author":"Chakfe","year":"2020","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2025060915514434300_ezaf171-B7","article-title":"EACTS\/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ","volume":"6","author":"Czerny","year":"2024","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025060915514434300_ezaf171-B8","doi-asserted-by":"crossref","first-page":"e412","DOI":"10.1161\/CIR.0000000000000457","article-title":"Vascular graft infections, mycotic aneurysms, and endovascular infections: a scientific statement from the American Heart Association","volume":"134","author":"Wilson","year":"2016","journal-title":"Circulation"},{"key":"2025060915514434300_ezaf171-B9","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1111\/j.1469-0691.2011.03618.x","article-title":"Characteristics and prognosis in patients with prosthetic vascular graft infection: a prospective observational cohort study","volume":"18","author":"Legout","year":"2012","journal-title":"Clin Microbiol Infect"},{"key":"2025060915514434300_ezaf171-B10","doi-asserted-by":"crossref","first-page":"47","DOI":"10.20517\/2574-1209.2022.18","article-title":"Vascular graft infections","volume":"6","author":"Van Hemelrijck","year":"2022","journal-title":"Vessel Plus"},{"key":"2025060915514434300_ezaf171-B11","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.ijantimicag.2015.04.014","article-title":"Medical treatment of prosthetic vascular graft infections: review of the literature and proposals of a working group","volume":"46","author":"Revest","year":"2015","journal-title":"Int J Antimicrob Agents"},{"key":"2025060915514434300_ezaf171-B12","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1093\/ejcts\/ezw190","article-title":"Endocarditis in patients with ascending aortic prosthetic graft: a case series from a national multicentre registry","volume":"50","author":"Ramos","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025060915514434300_ezaf171-B13","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1093\/ejcts\/ezw150","article-title":"Management of early graft infections in the ascending aorta and aortic arch: a comparison between graft replacement and graft preservation techniques","volume":"50","author":"Umminger","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025060915514434300_ezaf171-B14","doi-asserted-by":"crossref","first-page":"1990","DOI":"10.1016\/S0003-4975(99)00355-0","article-title":"Management of thoracic aortic graft infections","volume":"67","author":"Coselli","year":"1999","journal-title":"Ann Thorac Surg"},{"key":"2025060915514434300_ezaf171-B15","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/j.jtcvs.2007.05.059","article-title":"Options for managing infected ascending aortic grafts","volume":"134","author":"LeMaire","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025060915514434300_ezaf171-B16","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.hlc.2013.09.001","article-title":"Treatment of infected thoracic aortic prosthetic grafts with the in situ preservation strategy: a review of its history, surgical technique, and results","volume":"23","author":"Tossios","year":"2014","journal-title":"Heart Lung Circ"},{"key":"2025060915514434300_ezaf171-B17","doi-asserted-by":"crossref","DOI":"10.1093\/ejcts\/ezac551","article-title":"Thoracic aortic vascular graft infection: outcome after conservative treatment without graft removal","volume":"63","author":"Kouijzer","year":"2022","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025060915514434300_ezaf171-B18","first-page":"w13754","article-title":"Vascular graft infections","volume":"143","author":"Hasse","year":"2013","journal-title":"Swiss Med Wkly"},{"key":"2025060915514434300_ezaf171-B19","doi-asserted-by":"crossref","first-page":"3948","DOI":"10.1093\/eurheartj\/ehad193","article-title":"2023 ESC Guidelines for the management of endocarditis","volume":"44","author":"Delgado","year":"2023","journal-title":"Eur Heart J"},{"key":"2025060915514434300_ezaf171-B20","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1093\/cid\/ciad271","article-title":"The 2023 Duke-International Society for cardiovascular infectious diseases criteria for infective endocarditis: updating the modified Duke criteria","volume":"77","author":"Fowler","year":"2023","journal-title":"Clin Infect Dis"},{"key":"2025060915514434300_ezaf171-B21","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1007\/s00259-018-4069-1","article-title":"The role of FDG PET\/CT in therapy control of aortic graft infection","volume":"45","author":"Husmann","year":"2018","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"2025060915514434300_ezaf171-B22","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1086\/313753","article-title":"Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis","volume":"30","author":"Li","year":"2000","journal-title":"Clin Infect Dis"},{"key":"2025060915514434300_ezaf171-B23","doi-asserted-by":"publisher","DOI":"10.4414\/cvm.2022.w10142","article-title":"Five years\u2019 experience of the endocarditis team in a tertiary referral centre","volume":"5","author":"Van Hemelrick","year":"2022","journal-title":"Cardiovasc Med"},{"key":"2025060915514434300_ezaf171-B24","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1097\/SLA.0b013e3182365864","article-title":"Long-term results of vascular graft and artery preserving treatment with negative pressure wound therapy in Szilagyi grade III infections justify a paradigm shift","volume":"254","author":"Mayer","year":"2011","journal-title":"Ann Surg"},{"key":"2025060915514434300_ezaf171-B25","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1016\/j.jtcvs.2007.02.055","article-title":"Management of prosthetic graft infection after surgery of the thoracic aorta: removal of the prosthetic graft is not necessary","volume":"134","author":"Akowuah","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025060915514434300_ezaf171-B26","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1016\/j.jtcvs.2014.06.025","article-title":"Homograft use in reoperative aortic root and proximal aortic surgery for endocarditis: a 12-year experience in high-risk patients","volume":"148","author":"Preventza","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025060915514434300_ezaf171-B27","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1093\/ejcts\/ezz328","article-title":"Prognostic assessment of valvular surgery in active infective endocarditis: multicentric nationwide validation of a new score developed from a meta-analysis","volume":"57","author":"Varela Barca","year":"2020","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025060915514434300_ezaf171-B28","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1093\/ejcts\/ezv223","article-title":"EuroSCORE II underestimates mortality after cardiac surgery for infective endocarditis","volume":"49","author":"Patrat-Delon","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025060915514434300_ezaf171-B29","doi-asserted-by":"crossref","first-page":"1223878","DOI":"10.3389\/fcvm.2023.1223878","article-title":"Dismal prognosis of patients with operative indication without surgical intervention in active left-sided infective endocarditis","volume":"10","author":"Van Hemelrijck","year":"2023","journal-title":"Front Cardiovasc Med"},{"key":"2025060915514434300_ezaf171-B30","doi-asserted-by":"crossref","first-page":"3034","DOI":"10.1111\/jocs.14967","article-title":"The fate of active left-side infective endocarditis with operative indication in absence of valve surgery","volume":"35","author":"Carino","year":"2020","journal-title":"J Card Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezaf171\/63397373\/ezaf171.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/67\/6\/ezaf171\/63397373\/ezaf171.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/67\/6\/ezaf171\/63397373\/ezaf171.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T19:51:55Z","timestamp":1749498715000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezaf171\/8152695"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,29]]},"references-count":30,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6,3]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaf171","relation":{},"ISSN":["1873-734X"],"issn-type":[{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,6]]},"published":{"date-parts":[[2025,5,29]]},"article-number":"ezaf171"}}