Abstract
ObjectiveThe 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).MethodsFrom 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 Québec (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.ResultsFive (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.ConclusionsWhile 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.
Highlights
The cardiac surgery community has recently suggested that per-cutaneous aortic valve replacement be used to replace diseased aortic valves in an aging population with significant co-morbidities
Data collection procedures complied with the ethical rules of our research centre, and informed consent was obtained from the patients prior to surgery
A 26 Fr sheath is inserted in the left ventricular apex and a 23 or 26 mm Edwards Sapien bioprosthesis (ES) prosthesis is inserted under rapid pacing, trans-oesophageal guidance, and fluoroscopy [11]
Summary
The present study was a single-centre prospective case series. One hundred and fifty four consecutive patients who underwent TA-TAVI with an Edwards Sapien (Edwards Lifesciences, Irvine, CA, USA) bioprosthesis between April 2007 and December 2011 were included. In this retrospective analysis of prospectively collected data. Perioperative variables, and postoperative complications were prospectively recorded in a dedicated registry. Data collection procedures complied with the ethical rules of our research centre, and informed consent was obtained from the patients prior to surgery. The procedure is performed on heparinized patients (ACT 250 s) in a surgical theatre with fluoroscopy and under transoesophageal guidance with full monitoring. A 26 Fr sheath is inserted in the left ventricular apex and a 23 or 26 mm ES prosthesis is inserted under rapid pacing, trans-oesophageal guidance, and fluoroscopy [11]. Statistical analysis Continuous variables are reported as means ± standard deviation, or as medians ± interquartile range, when appropriate.
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