ORIGINAL ARTICLE – ADULT CARDIAC
Interactive CardioVascular and Thoracic Surgery 20 (2015) 701–706 doi:10.1093/icvts/ivv024 Advance Access publication 27 February 2015
Cite this article as: Oda T, Minatoya K, Kobayashi J, Okita Y, Akashi H, Tanaka H et al. Prosthetic vascular graft infection through a median sternotomy: a multicentre review. Interact CardioVasc Thorac Surg 2015;20:701–6.
Prosthetic vascular graft infection through a median sternotomy: a multicentre review†
a b c d e f g
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan Department of Cardiovascular Surgery, Kobe University Hospital, Kobe, Japan Department of Cardiovascular Surgery, Kurume University Hospital, Kurume, Japan Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Japan Department of Cardiovascular Surgery, Tohoku University Hospital, Sendai, Japan Department of Cardiovascular Surgery, University of the Ryukyu’s Hospital, Okinawa, Japan Department of Prevenitive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
* Corresponding author. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan. Tel: +81-6-68335012; fax: +81-6-68339865; e-mail: [email protected] (K. Minatoya). Received 17 September 2014; received in revised form 10 December 2014; accepted 22 December 2014
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
Interactive CardioVascular and Thoracic Surgery 20 (2015) 701–706 doi:10.1093/icvts/ivv024 Advance Access publication 27 February 2015
Cite this article as: Oda T, Minatoya K, Kobayashi J, Okita Y, Akashi H, Tanaka H et al. Prosthetic vascular graft infection through a median sternotomy: a multicentre review. Interact CardioVasc Thorac Surg 2015;20:701–6.
Prosthetic vascular graft infection through a median sternotomy: a multicentre review†
a b c d e f g
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan Department of Cardiovascular Surgery, Kobe University Hospital, Kobe, Japan Department of Cardiovascular Surgery, Kurume University Hospital, Kurume, Japan Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Japan Department of Cardiovascular Surgery, Tohoku University Hospital, Sendai, Japan Department of Cardiovascular Surgery, University of the Ryukyu’s Hospital, Okinawa, Japan Department of Prevenitive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
* Corresponding author. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan. Tel: +81-6-68335012; fax: +81-6-68339865; e-mail: [email protected] (K. Minatoya). Received 17 September 2014; received in revised form 10 December 2014; accepted 22 December 2014
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
