经导管主动脉瓣植入术手术部位感染发病率及管理

楚楚

J Cardiothorac Surg. 2012 Nov 13;7(1):122. [Epub ahead of print]
Surgical site infections following transcatheter apical aortic valve implantation: incidence and management.Baillot R, Fréchette E, Cloutier D, Rodès-Cabau J, Doyle D, Charbonneau E, Mohammadi S, Dumont E.
AbstractABSTRACT:

OBJECTIVE: The present study was undertaken to examine the incidence and management of surgical site infection (SSI) in patients submitted to transapical transcatheter aortic valve implantation (TA-TAVI).

METHODS:

From April 2007 to December 2011, 154 patients underwent TA-TAVI with an Edwards Sapien bioprosthesis (ES) at the Institut Universitaire de Cardiologie et Pneumologie de Quebec (IUCPQ) as part of a multidisciplinary program to prospectively evaluate percutaneous aortic valve implantation. Patient demographics, perioperative variables, and postoperative complications were recorded in a prospective registry.

RESULTS:

Five (3.2%) patients in the cohort presented with an SSI during the study period. The infections were all hospital-acquired (HAI) and were considered as organ/space SSI's based on Center for Disease Control criteria (CDC). Within the first few weeks of the initial procedure, these patients presented with an abscess or chronic draining sinus in the left thoracotomy incision and were re-operated. The infection spread to the apex of the left ventricle in all cases where pledgeted mattress sutures could be seen during debridement. Patients received multiple antibiotic regimens without success until the wound was surgically debrided and covered with viable tissue. The greater omentum was used in three patients and the pectoralis major muscle in the other two. None of the patients died or had a recurrent infection. Three of the patients were infected with Staphylococcus epidermidis, one with Staphylococcus aureus, and one with Enterobacter cloacae. Patients with surgical site infections were significantly more obese with higher BMI (31.4+/-3.1 vs 26.2+/-4.4 p=0.0099) than the other patients in the cohort.研究期间共发生SSI 5例（3.2%），均为医院获得性感染和器官腔隙感染。在手术后最初几周，手术部位感染患者在左胸廊切口部位有脓肿或慢性引流窦道，并进行了二次手术。在清创过程中通过纱布垫可以看到感染蔓延到左心室的尖端。使用了多种抗菌药物但感染没有得到有效控制，直到进行外科清创和长出肉芽组织。其中有三例患者使用了大网膜，二位患者使用了胸大肌。没有患者死亡或发生继发感染。3例是表葡感染，1例是金葡感染，1例是阴沟肠杆菌感染。感染患者的体重指数明显高于非感染患者。

CONCLUSIONS:

While TA-TAVI is a minimally invasive technique, SSIs, which are associated with obesity, remain a concern. Debridement and rib resection followed by wound coverage with the greater omentum and/or the pectoralis major muscle were used successfully in these patients.经导管主动脉瓣植入术这种微创手术，SSI与肥胖有关，仍然应引起关注。清创和肋骨切除后使用大网膜和胸大肌成功治疗感染患者。