Tatsuya Oda1, Kenji Minatoya2, Junjiro Kobayashi1, Yutaka Okita3, Hidetoshi Akashi4, Hiroyuki Tanaka4, Nobuyoshi Kawaharada5, Yoshikatsu Saiki6, Yukio Kuniyoshi7, Kunihiro Nishimura8. 1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan. 2. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan minatoya@ncvc.go.jp. 3. Department of Cardiovascular Surgery, Kobe University Hospital, Kobe, Japan. 4. Department of Cardiovascular Surgery, Kurume University Hospital, Kurume, Japan. 5. Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Japan. 6. Department of Cardiovascular Surgery, Tohoku University Hospital, Sendai, Japan. 7. Department of Cardiovascular Surgery, University of the Ryukyu's Hospital, Okinawa, Japan. 8. Department of Prevenitive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Abstract
OBJECTIVES: The aim of this study is to analyse the treatment outcomes of thoracic prosthetic graft infection. METHODS: A retrospective chart review was conducted at six hospitals and included the records of 68 patients treated for postoperative prosthetic vascular graft infection (mean age: 62.3 ± 15.1, male 51) from January 2000 to December 2013. The number of patients and the locations of the treated infections were as follows: 13 for aortic root, 16 for ascending aorta, 35 for aortic arch and 4 for aortic root to arch. In-hospital infection occurred in 43 patients and after discharge in 25. RESULTS: The mean follow-up time was 2.0 ± 2.3 years. The follow-up rate was 94.1%. The most commonly isolated micro-organism was Staphylococcus aureus (72.1%). Rereplacement of infectious graft was performed in 18 patients (Dacron graft in 12, homograft in 4 and rifampicin-bonded Dacron graft in 2). The overall hospital mortality rate was 35.3% (24/68). The mortality rate among the patients with graft rereplacement was 33.3% (6/18), with pedicled muscle flaps or pedicled omental flaps to cover the graft 25.9% (7/27), with irrigation 55.0% (11/20) and on antibiotic therapy only 0% (0/3). Our multivariate analysis demonstrated that the risk factors of hospital death increased in the absence of pedicled flaps (muscle or omentum) to cover the graft (P = 0.001), age over 55 (P = 0.003), time from onset of initial operation <1 week (P = 0.031) and period before 2008 (P = 0.001). The overall 1-year survival rate was 58.6%. CONCLUSIONS: The treatment outcomes of thoracic prosthetic vascular graft infection have not been satisfactory. However, the use of pedicled muscle or omental flaps to cover the graft could improve the outcomes.
OBJECTIVES: The aim of this study is to analyse the treatment outcomes of thoracic prosthetic graft infection. METHODS: A retrospective chart review was conducted at six hospitals and included the records of 68 patients treated for postoperative prosthetic vascular graft infection (mean age: 62.3 ± 15.1, male 51) from January 2000 to December 2013. The number of patients and the locations of the treated infections were as follows: 13 for aortic root, 16 for ascending aorta, 35 for aortic arch and 4 for aortic root to arch. In-hospital infection occurred in 43 patients and after discharge in 25. RESULTS: The mean follow-up time was 2.0 ± 2.3 years. The follow-up rate was 94.1%. The most commonly isolated micro-organism was Staphylococcus aureus (72.1%). Rereplacement of infectious graft was performed in 18 patients (Dacron graft in 12, homograft in 4 and rifampicin-bonded Dacron graft in 2). The overall hospital mortality rate was 35.3% (24/68). The mortality rate among the patients with graft rereplacement was 33.3% (6/18), with pedicled muscle flaps or pedicled omental flaps to cover the graft 25.9% (7/27), with irrigation 55.0% (11/20) and on antibiotic therapy only 0% (0/3). Our multivariate analysis demonstrated that the risk factors of hospital death increased in the absence of pedicled flaps (muscle or omentum) to cover the graft (P = 0.001), age over 55 (P = 0.003), time from onset of initial operation <1 week (P = 0.031) and period before 2008 (P = 0.001). The overall 1-year survival rate was 58.6%. CONCLUSIONS: The treatment outcomes of thoracic prosthetic vascular graft infection have not been satisfactory. However, the use of pedicled muscle or omental flaps to cover the graft could improve the outcomes.
Authors: Ashley T Giammarino; Iam Claire Sarmiento; SJacob Scheinerman; John Winalski; Richard S Lazzaro; Derek R Brinster; Jonathan M Hemli Journal: J Med Case Rep Date: 2022-05-10
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Authors: Laura Filaire; Olaf Mercier; Agathe Seguin-Givelet; Olivier Tiffet; Pierre Emmanuel Falcoz; Pierre Mordant; Pierre-Yves Brichon; Philippe Lacoste; Axel Aubert; Pascal Thomas; Françoise Le Pimpec-Barthes; Ioana Molnar; Magali Vidal; Marc Filaire; Géraud Galvaing Journal: Interact Cardiovasc Thorac Surg Date: 2022-02-21