Reply to the Editor

Article Outline

• References
• Copyright

CTSNet classification: 18, 40, 41

Bozzani and colleagues¹ state that surgical correction of an aortobronchial fistula, particularly open correction of a thoracic aneurysm, carries a fairly high postoperative incidence of stent-graft infection. To the contrary, minimal infection rates were observed after endovascular stent placement. The authors question whether antibiotic therapy should be administrated after this minimally invasive operational procedure.¹, ² There is scarce literature on immunologic consequences after stent implantation in humans. According to immunologic data obtained from patients undergoing heart operations with cardiopulmonary support and abdominal surgery, any operation performed in humans induces a state of immune suppression in vivo. Therefore, patients undergoing heart surgery (cardiopulmonary support) should receive aggressive 5-day antibiotic treatment in accordance with the insight of an induced “systemic immune suppression” after heart surgery.³, ⁴ In regard to the ongoing discussion of antibiotic treatment after endovascular stent implantation, the following approach seems to be feasible. Studies have to be initiated to investigate the immunologic consequence of open and endovascular stent implantation in humans (eg, abdominal aorta aneurysm repair, open, closed), and “yes,” antibiotic treatment should be applied for 4 to 5 days after endovascular stent placement to potentially “prohibit” pain from infection (local, systemic) in patients.

Back to Article Outline

References 

1. Bozzani A, Arici V, Odero A. What is the real risk of stent graft infection in the treatmental of aorta-bronchial fistulas?. J Thorac Cardiovasc Surg. 2010;139:511–512
   • View In Article
   • Full Text
   • Full-Text PDF (51 KB)
   • CrossRef
2. Hacker S, Langenberger H, Plank C, Gorlitzer M, Ehrlich M, Dolak W, et al. Management of aortobronchial fistula developing 27 years after open aortic surgery by means of endovascular stent grafting. J Thorac Cardiovasc Surg. 27 April 2009;[Epub ahead of print]
   • View In Article
3. Brunner M, Krenn C, Roth G, Moser B, Dworschak M, Jensen-Jarolim E, et al. Increased levels of soluble ST2 protein and IgG1 production in patients with sepsis and trauma. Intensive Care Med. 2004;30:1468–1473Epub 2004 Feb 28
   • View In Article
   • MEDLINE
4. Szerafin T, Niederpold T, Mangold A, Hoetzenecker K, Hacker S, Roth G, et al. Secretion of soluble ST2-possible explanation for systemic immunosuppression after heart surgery. Thorac Cardiovasc Surg. 2009;57:25–29
   • View In Article
   • CrossRef