초록접수 현황
| 16F-166 | 포럼 발표 |
Outcome of Open Repair of Mycotic Thoracic and Abdominal Aortic Aneurysm
Hyo-Hyun Kim, Seung-Hyun Lee, Young-Nam Youn, Sak Lee, Hyun-Chel Joo
Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
Background : The purpose of this study was to evaluate the intermediate-term outcomes of open repair of mycotic thoracic and abdominal aneurysms.
Methods : From 2006 to 2016, 19 patients underwent open repair of ascending (n=3, 15.8%), descending thoracic (n=6, 31.6 %), thoracoabdominal (n=2, 10.5%) and abdominal (n=8, 42.1%) mycotic aortic aneurysms. Mean age was 62.0 ± 16.0 years and 13 patients (68.4%) were male. Diagnosis was confirmed utilizing culture study and computed tomography imaging. Perioperative outcomes, intermediate-term survival, and reinfection rates were reviewed. Mean follow-up time was 23.3 ± 23.8 months (range 3 to 83).
Results : Most patients presented with either aneurysm-related symptoms or a clinical picture of sepsis. 10 patients (52.6%) had aneurysm-related pain, and 5 (26.3%) of them had contained rupture. On culture analysis, 4 (21%) grew staphylococcus aureus, 5 (26.3%) grew gram negative organisms, and 8 cultures (42.1%) had negative results. Mean time from onset of illness to surgery was 14.5 days (range, 0 to 75 days). Aortic continuity was restored in situ with a prosthetic Dacron graft (n= 15, 78.9%), homograft (n=3, 15.8%) or Gore-Tex (n=1, 5.3%). Soft tissue coverage of the prosthesis was performed in 9 patients (omental flap n=8, pectoralis major muscle flap n=1). There was two in-hospital death (12%) secondary to sepsis and acute myocardial infarction. The mean ICU stay and in-hospital stay was 11 ± 19.7 days and 52 ± 44.6 days, individually. There was only one case of graft re-infection. Actuarial 5-year survival was 68 ± 21.8 %. .
Conclusion : Open repair of mycotic aortic aneurysms remains the gold standard of therapy. Aggressive intraoperative debridement with in situ prosthetic reconstruction with soft tissue coverage permits a high rate of success in this very high risk cohort of patients
Methods : From 2006 to 2016, 19 patients underwent open repair of ascending (n=3, 15.8%), descending thoracic (n=6, 31.6 %), thoracoabdominal (n=2, 10.5%) and abdominal (n=8, 42.1%) mycotic aortic aneurysms. Mean age was 62.0 ± 16.0 years and 13 patients (68.4%) were male. Diagnosis was confirmed utilizing culture study and computed tomography imaging. Perioperative outcomes, intermediate-term survival, and reinfection rates were reviewed. Mean follow-up time was 23.3 ± 23.8 months (range 3 to 83).
Results : Most patients presented with either aneurysm-related symptoms or a clinical picture of sepsis. 10 patients (52.6%) had aneurysm-related pain, and 5 (26.3%) of them had contained rupture. On culture analysis, 4 (21%) grew staphylococcus aureus, 5 (26.3%) grew gram negative organisms, and 8 cultures (42.1%) had negative results. Mean time from onset of illness to surgery was 14.5 days (range, 0 to 75 days). Aortic continuity was restored in situ with a prosthetic Dacron graft (n= 15, 78.9%), homograft (n=3, 15.8%) or Gore-Tex (n=1, 5.3%). Soft tissue coverage of the prosthesis was performed in 9 patients (omental flap n=8, pectoralis major muscle flap n=1). There was two in-hospital death (12%) secondary to sepsis and acute myocardial infarction. The mean ICU stay and in-hospital stay was 11 ± 19.7 days and 52 ± 44.6 days, individually. There was only one case of graft re-infection. Actuarial 5-year survival was 68 ± 21.8 %. .
Conclusion : Open repair of mycotic aortic aneurysms remains the gold standard of therapy. Aggressive intraoperative debridement with in situ prosthetic reconstruction with soft tissue coverage permits a high rate of success in this very high risk cohort of patients
책임저자: Hyun-Chel Joo
Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
발표자: Hyo-Hyun Kim, E-mail : ysgs@yuhs.ac