Omental Flap Coverage for Management of Thoracic Aortic Graft Infection
| Autor: | Stephen J. Kovach, William Piwnica-Worms, Saïd C. Azoury, John P. Fischer, Prashanth Vallabhajosyula, John T. Stranix, Geoffrey M. Kozak, J. Andres Hernandez, Joshua C. Grimm |
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| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Aorta Univariate analysis business.industry Incidence (epidemiology) Retrospective cohort study 030204 cardiovascular system & hematology medicine.disease Surgery 03 medical and health sciences Pseudoaneurysm 0302 clinical medicine 030228 respiratory system Cardiothoracic surgery medicine.artery Cohort medicine Cardiology and Cardiovascular Medicine Complication business |
| Zdroj: | The Annals of Thoracic Surgery. 109:1845-1849 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2019.09.041 |
| Popis: | Background Since the first reported use of prosthetic aortic grafts, infection has remained a feared complication. Pedicled omentum is the preferred flap in managing thoracic aortic graft infection (TAGI); however the literature is sparse. The authors present their experience with TAGI managed with pedicled omental flaps. Methods A single-institutional review from 2007 to 2018 was performed to analyze postoperative outcomes of omental flap reconstruction, performed by 2 surgeons, after a confirmed diagnosis of TAGI. The primary outcomes of overall complication rate, 30-day mortality, and in-hospital mortality were evaluated with univariate analysis. Results Twenty patients requiring omental flap reconstruction after TAGI met inclusion criteria. The patient cohort included 14 men and 6 women with a mean age of 60.6 ± 12.9 years and a mean Charlson comorbidity index of 3.3 ± 2.1. Nine patients (45%) received omental flap reconstruction at the time of incipient TAGI surgical management by the cardiothoracic surgery team, whereas 11 patients received delayed reconstruction (mean, 6.22 days [range, 1-27]). The most common complications were graft leak (20%) and pseudoaneurysm (25%), with only 1 patient developing recurrent infection. Overall 30-day mortality was 20%. Chronic obstructive pulmonary disease and delayed omental flap reconstruction were associated with 30-day mortality (P = .04). Four of 11 patients (36.4%) who received delayed omental flap reconstruction died within 30 days, whereas 0 of 9 patients (0%) in the immediate omental coverage group died within 30 days (P = .043). Conclusions High mortality rates associated with TAGI exemplify the challenges associated with this disease process and patient population. Pedicled omentum is a safe adjunct with promising results to the management of TAGI while significantly reducing the risk of reinfection. |
| Databáze: | OpenAIRE |
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