Akil Ali, Rehers Stephanie, Köhler Christian, Richter Lars, Semik Michael, Ziegeler Stephan, Fischer Stefan
Department of Thoracic Surgery and Lung Support, Ibbenbueren General Hospital, Ibbenbueren, Germany.
Department of Anesthesiology, Intensive Care Medicine and Pain Management, Ibbenbueren General Hospital, Ibbenbueren, Germany.
J Thorac Dis. 2021 Aug;13(8):4661-4667. doi: 10.21037/jtd-20-2886.
Postsurgical pleural infection is a life-threatening complication after implantation of artificial devices such as ventricular assist devices (VADs). The treatment can be challenging and the evidence in the literature is very limited. Here we report our multidisciplinary approach of the management of pleural infection after VAD implantation.
Between March 2014 and December 2019, 33 patients developed postoperative pleural infection after VAD implantation and underwent thoracic surgical intervention at our institution. All patients were prospectively enrolled in this analysis. Data were retrospectively analyzed. Primary outcome was the 90-day mortality rate. Length of ICU stay related to pleural infection, chest tube duration, re-thoracotomy rate and length of ventilatory support represented secondary outcomes.
The 90-day mortality rate was 6% (2 patients). The mean ICU stay related to the pleural infection was 6 days (2-24 days). Video-assisted thoracoscopic surgery (VATS) was performed in all patients. Conversion to thoracotomy was necessary in 12 cases. Decortication and parietal pleurectomy in addition to hematoma and empyema removal was performed in all patients. Due to diffuse bleeding, packing of the thoracic cavity with temporary thoracic closure was necessary in 10 patients. Depacking was performed after a mean of 3 days (3-7 days). Recurrent empyema or bleeding after definitive chest closure was not observed. Lung resection was performed in 3 patients.
Thoracic surgical management of pleural infection in patients after VAD implantation is challenging and complicated due to the inevitable anticoagulative therapy. A perioperative multidisciplinary management which includes the early involvement of thoracic surgical expertise helps to improve survival in this very complex patient cohort.
术后胸膜感染是植入心室辅助装置（VAD）等人工装置后危及生命的并发症。治疗具有挑战性，且文献中的证据非常有限。在此，我们报告我们对VAD植入术后胸膜感染的多学科管理方法。
2014年3月至2019年12月期间，33例患者在VAD植入术后发生术后胸膜感染，并在我们机构接受了胸外科手术干预。所有患者均前瞻性纳入本分析。对数据进行回顾性分析。主要结局是90天死亡率。与胸膜感染相关的重症监护病房（ICU）住院时间、胸管留置时间、再次开胸率和通气支持时间为次要结局。
90天死亡率为6%（2例患者）。与胸膜感染相关的ICU平均住院时间为6天（2 - 24天）。所有患者均接受了电视辅助胸腔镜手术（VATS）。12例患者需要转为开胸手术。所有患者均进行了除血肿和脓胸清除外的纤维板剥脱术和壁层胸膜切除术。由于弥漫性出血，10例患者需要用临时胸腔闭合术对胸腔进行填塞。平均3天（3 - 7天）后进行了填塞物清除。未观察到确定性胸壁闭合后复发性脓胸或出血。有3例患者进行了肺切除术。
由于不可避免的抗凝治疗，VAD植入术后患者胸膜感染的胸外科管理具有挑战性且复杂。围手术期多学科管理，包括胸外科专业知识的早期介入，有助于提高这一非常复杂患者群体的生存率。
