Beyond the immediate light: reappraising open surgery for long-term outcomes in infected native aortic aneurysms

This commentary refers to ‘Infected native aortic aneurysms: epidemiology, management, and outcomes based on a nationwide population-based study’, by C-C. Lee et al., https://doi.org/10.1093/eurheartj/ehaf449 and the discussion piece ‘A critical examination of methodological limitations to diagnose infective native aortic aneurysms’, by K. Sörelius and T.R. Wyss, https://doi.org/10.1093/eurheartj/ehaf808. We sincerely thank Dr Sørelius for his thoughtful commentary. As one of the pioneers and leading experts in this challenging field, his insights have greatly inspired our own research journey and highlight the importance of continued academic exchange. Historically, ‘mycotic aneurysm’ was first described by Sir William Osler in 1885, when he reported fungal-like vegetations as the pathological hallmark drawing attention to the infectious nature of these aneurysms. The terminology has since evolved to ‘infected native aortic aneurysm (INAA)’ to more accurately reflect its pathogenesis. It is noteworthy that Osler’s original observation also highlights a principle still highly relevant today—the diagnostic and therapeutic value of obtaining surgical specimens. Despite the rarity of this condition, recent Delphi consensus documents have established needed definitions, diagnostic criteria, algorithms, and treatment frameworks, which have since been incorporated into the 2024 ESVS Clinical Practice Guidelines.1 These contributions provide essential guidance for clinicians worldwide, including those of us working in regions with higher disease prevalence.