期刊
INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY
卷 34, 期 3, 页码 378-385出版社
OXFORD UNIV PRESS
DOI: 10.1093/icvts/ivab337
关键词
Graft infection; Superior vena cava reconstruction; Non-small-cell lung cancer; Empyema; Mediastinal tumours; Mediastinitis
This study reports on the management of superior vena cava graft infection. The majority of infections were caused by polytetrafluoroethylene grafts, and the treatment consisted of either conservative or surgical strategies. Graft removal was not always necessary for all cases.
OBJECTIVES To report our experience on the management of superior vena cava graft infection. METHODS Between 2001 and 2018, patients with superior vena cava synthetic graft or patch reconstruction after resection of intrathoracic tumours or benign disease were selected retrospectively from the French EPITHOR database and participating thoracic centres. Our study population includes patients with superior vena cava graft infection, defined according to the MAGIC consensus. Superior vena cava synthetic grafts in an empyema or mediastinitis were considered as infected. RESULTS Of 111 eligible patients, superior vena cava graft infection occurred in 12 (11.9%) patients with a polytetrafluoroethylene graft secondary to contiguous contamination. Management consisted of either conservative treatment with chest tube drainage and antibiotics (n = 3) or a surgical graft-sparing strategy (n = 9). Recurrence of infection appears in 6 patients. Graft removal was performed in 2 patients among the 5 reoperated patients. The operative mortality rate was 25%. CONCLUSIONS Superior vena cava graft infection may develop as a surgical site infection secondary to early mediastinitis or empyema. Graft removal is not always mandatory but should be considered in late or recurrent graft infection or in infections caused by aggressive microorganisms (virulent or multidrug resistant bacteria or fungi).
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