抄録
Background: Aortic graft infection (AGI) is an intractable complication of prosthetic graft replacement surgery. The selection of a reconstruction method is controversial, especially in cases where omental flaps are not available.
Methods: A retrospective survey was conducted based on the medical records of patients who underwent prosthetic graft replacement with an anterolateral partial sternotomy (ALPS) approach and mediastinal reconstruction with transthoracic latissimus dorsi (LD) flap at Kobe University Hospital between July 2019 and May 2021. In the ALPS approach, the left third intercostal space was incised in addition to the conventional median sternotomy. The left fifth rib was partially excised to create a passage between the lateral thoracic area and thoracic cavity (transthoracic route). After the graft replacement surgery, the left LD flap was passed through the transthoracic route to fill the dead space around the graft.
Results: Our study included five patients (four males; mean age, 74.0 years). Three and two patients experienced AGI recurrence and infectious aortic aneurysms. In all cases, the omental flap was unavailable for mediastinal reconstruction owing to a history of laparotomy. One patient with an infectious aortic aneurysm died of heart failure on postoperative day 24. The mean hospital stay for the four survivors was 67.3 days. The mean postoperative follow-up was 513.3 days with no recurrence of infection.
Discussion: Compared to the extra-thoracic route, the transthoracic route shortens the distance from the base of the LD flap to the aortic graft, allowing more muscle tissue to be filled into the dead space (between the pectoralis major and thoracic wall). Trans-thoracic LD flap transfer using the ALPS approach is a versatile reconstruction method for treating AGI when the omental flap is unavailable, especially for recurrent graft infections.
