title: Surgical site infections following transcatheter apical aortic valve implantation: incidence and management.
abstract: OBJECTIVE
  The present study was undertaken to examine the incidence and management of surgical site infection (SSI) in patients submitted to transapical transcatheter aortic valve implantation (TA-TAVI).
  
  
  METHODS
  From April 2007 to December 2011, 154 patients underwent TA-TAVI with an Edwards Sapien bioprosthesis (ES) at the Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ) as part of a multidisciplinary program to prospectively evaluate percutaneous aortic valve implantation. Patient demographics, perioperative variables, and postoperative complications were recorded in a prospective registry.
  
  
  RESULTS
  Five (3.2%) patients in the cohort presented with an SSI during the study period. The infections were all hospital-acquired (HAI) and were considered as organ/space SSI's based on Center for Disease Control criteria (CDC). Within the first few weeks of the initial procedure, these patients presented with an abscess or chronic draining sinus in the left thoracotomy incision and were re-operated. The infection spread to the apex of the left ventricle in all cases where pledgeted mattress sutures could be seen during debridement. Patients received multiple antibiotic regimens without success until the wound was surgically debrided and covered with viable tissue. The greater omentum was used in three patients and the pectoralis major muscle in the other two. None of the patients died or had a recurrent infection. Three of the patients were infected with Staphylococcus epidermidis, one with Staphylococcus aureus, and one with Enterobacter cloacae. Patients with surgical site infections were significantly more obese with higher BMI (31.4±3.1 vs 26.2±4.4 p=0.0099) than the other patients in the cohort.
  
  
  CONCLUSIONS
  While TA-TAVI is a minimally invasive technique, SSIs, which are associated with obesity, remain a concern. Debridement and rib resection followed by wound coverage with the greater omentum and/or the pectoralis major muscle were used successfully in these patients.
authors.affiliation: Department of Cardiac Surgery, Université Laval, Québec City, Qc, Canada. richard.baillot@chg.ulaval.ca
authors.forename: Richard
authors.initials: R
authors.lastname: Baillot
authors.forename: Éric
authors.initials: É
authors.lastname: Fréchette
authors.forename: Daniel
authors.initials: D
authors.lastname: Cloutier
authors.forename: Josep
authors.initials: J
authors.lastname: Rodès-Cabau
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.forename: Éric
authors.initials: É
authors.lastname: Charbonneau
authors.forename: Siamak
authors.initials: S
authors.lastname: Mohammadi
authors.forename: Éric
authors.initials: É
authors.lastname: Dumont
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000628:therapy*