Department of Thoracic and Endocrine Surgery, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France.
Department of Thoracic and Vascular Surgery and Heart and Lung Transplantation, Hôpital Marie Lannelongue, Paris, France.
Interact Cardiovasc Thorac Surg. 2022 Feb 21;34(3):378-385. doi: 10.1093/icvts/ivab337.
To report our experience on the management of superior vena cava graft infection.
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.
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%.
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).
报告我们在处理上腔静脉移植物感染方面的经验。
2001 年至 2018 年间，从法国 EPITHOR 数据库和参与的胸科中心回顾性选择了因切除胸内肿瘤或良性疾病而接受上腔静脉合成移植物或补片重建的患者。我们的研究人群包括根据 MAGIC 共识定义的上腔静脉移植物感染患者。脓胸或纵隔炎中的上腔静脉合成移植物被认为是感染的。
在 111 名符合条件的患者中，12 名（11.9%）聚四氟乙烯移植物患者发生上腔静脉移植物感染，继发于邻近污染。治疗方法包括胸腔引流和抗生素的保守治疗（n=3）或保留移植物的手术策略（n=9）。6 例患者出现感染复发。在 5 例再次手术的患者中，有 2 例患者进行了移植物切除。手术死亡率为 25%。
上腔静脉移植物感染可能继发于早期纵隔炎或脓胸而成为手术部位感染。并非总是需要移植物切除，但应考虑在晚期或复发性移植物感染或由侵袭性微生物（毒力或多药耐药细菌或真菌）引起的感染中进行。
