Prosthetic vascular graft infection through a median sternotomy: a multicentre review †.
OBJECTIVE
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.
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
Tatsuya
T
Oda
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan minatoya@ncvc.go.jp.
Kenji
K
Minatoya
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
Junjiro
J
Kobayashi
Department of Cardiovascular Surgery, Kobe University Hospital, Kobe, Japan.
Yutaka
Y
Okita
Department of Cardiovascular Surgery, Kurume University Hospital, Kurume, Japan.
Hidetoshi
H
Akashi
Department of Cardiovascular Surgery, Kurume University Hospital, Kurume, Japan.
Hiroyuki
H
Tanaka
Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Japan.
Nobuyoshi
N
Kawaharada
Department of Cardiovascular Surgery, Tohoku University Hospital, Sendai, Japan.
Yoshikatsu
Y
Saiki
Department of Cardiovascular Surgery, University of the Ryukyu's Hospital, Okinawa, Japan.
Yukio
Y
Kuniyoshi
Department of Prevenitive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Kunihiro
K
Nishimura
D000368:Aged; D001013:Aorta, Thoracic / Q000382:microbiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D020878:Device Removal / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009852:Omentum / Q000601:surgery; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects / Q000401:mortality; D013524:Surgical Flaps; D007507:Therapeutic Irrigation; D013997:Time Factors; D016896:Treatment Outcome
Mediastinitis; Omentopexy; Prosthetic vascular graft infection