초록접수 현황
| 16F-085 | 구연 발표 |
Is Necessary to Remove Prosthetic Graft at All Time in Thoracic Aortic Graft Infection?
Min Suk Choi, Jin Ho Choi
Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
Background : Prosthetic aortic graft infection after thoracic aortic surgery is rare, but very severe complication. The optimal treatment requires adequate antibiotics treatment and appropriate surgical treatment. But, there are many debates about surgical methods. Sometimes, it may necessary to removal of prosthetic graft, it is often impossible to remove, practically. And, reentry through sternotomy in patients with intact sternal wound makes hesitate. Therefore, we evaluate the efficacy of the treatment of graft infection without graft removal.
Methods : 17 patients have treated for aortic graft infection from March 2009 to August 2016. 14 patients revealed perigraft infection during early postoperative periods, and received conservative treatment without graft removal. And 3 patients revealed pseudonaneurysm or aortoesophageal fistula during late postoperative periods, and received replacement of prosthetic aortic graft. 5 of 6 patients with sternal wound infection received omental flap or pectoralis muscle flap transposition and 1 patient treated with vacuum-assisted closure due to hemodynamic instability. 8 patients received drainage of pus through parasternal mediastinotomy without sternal reopening.
Results : Antibiotics treatment was continued for 4 weeks or 6 weeks and thhe most common organism was Staphylococcus epidermidis (6). 4 patients died during early postoperative periods and 13 patients could be discharged. 1 patient with aortoesophageal fistula died from aortic rupture and 3 patients dies from pneumonia or sepsis. There were no late death and no recurrence of aortic graft infection during follow-up periods.
Conclusion : It is possible to treat aortic graft infection after thoracic aortic surgery without prosthetic graft removal if it were not for esophageal fistula or pseudoaneurysm of anastomosis site. And parasternal approach without sternotomy makes not hesitate drainage in patients with intact sternal wound.
Methods : 17 patients have treated for aortic graft infection from March 2009 to August 2016. 14 patients revealed perigraft infection during early postoperative periods, and received conservative treatment without graft removal. And 3 patients revealed pseudonaneurysm or aortoesophageal fistula during late postoperative periods, and received replacement of prosthetic aortic graft. 5 of 6 patients with sternal wound infection received omental flap or pectoralis muscle flap transposition and 1 patient treated with vacuum-assisted closure due to hemodynamic instability. 8 patients received drainage of pus through parasternal mediastinotomy without sternal reopening.
Results : Antibiotics treatment was continued for 4 weeks or 6 weeks and thhe most common organism was Staphylococcus epidermidis (6). 4 patients died during early postoperative periods and 13 patients could be discharged. 1 patient with aortoesophageal fistula died from aortic rupture and 3 patients dies from pneumonia or sepsis. There were no late death and no recurrence of aortic graft infection during follow-up periods.
Conclusion : It is possible to treat aortic graft infection after thoracic aortic surgery without prosthetic graft removal if it were not for esophageal fistula or pseudoaneurysm of anastomosis site. And parasternal approach without sternotomy makes not hesitate drainage in patients with intact sternal wound.
책임저자: Jin Ho Choi
Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
발표자: Jin Ho Choi, E-mail : jinhc72@hanmail.net