The Use of Omental Flap Coverage for Complex Mediastinal Infections
Zachary Brennan1, Tyler Wallen2, Thomas Beaver3, Eric Jeng3, Tomas Martin3, George Arnaoutakis3.
1Michigan State University, East Lansing, MI, USA, 2Geisinger Health System, Wilkes-Barre, PA, USA, 3University of Florida, Department of Surgery, Division of Cardiovascular Surgery, Gainesville, FL, USA.
OBJECTIVE: Recurrent endocarditis and/or aortic graft infection presents a challenging clinical scenario with significant associated morbidity and mortality. The purpose of this study was to describe our approach to these patients.
METHODS: A retrospective review of a prospectively maintained database with patients from 2017-2019 who presented with complex prosthetic valve endocarditis and/or an aortic graft infection. Patients underwent the index operation depending upon the presenting pathology with placement of a mediastinal irrigation catheter for antibiotic infusion. Patients returned to the Operating Room 5 to 7 days later for mediastinal washout and omental flap coverage.
RESULTS: Seventeen patients were identified. Demographics and outcomes are described in Table 1. Cardiopulmonary bypass time was 253.8 + 114.1 minutes; cross clamp time was 185.8 + 86.3 minutes. One patient (5.9%) underwent valvular reoperation. Stroke rate was 5.9%. Thirty day mortality was 5.9%. Average follow up time was 11.35 months. Two patients (11.8%) died during follow up, neither of a cardiovascular cause.
CONCLUSIONS: The use of antibiotic irrigation and a planned reoperation with mediastinal washout and omental flap coverage for cases of recurrent endocarditis or graft infection is a safe effective technique with acceptable outcomes.
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