Background: The use of ventricular assist devices (VAD) for patients with end-stage cardiac failure awaiting a heart transplant has become increasingly common. VADs improve the longevity as well as the quality of life for these patients, and at the same time serve as a bridge to cardiac allograft transplantation until a donor heart is found. Furthermore, VADs have also been used to successfully hasten the recovery of a failing heart, at times obviating the need for cardiac transplantation. However, VAD related infections still remain a major problem complicating their long-term use. Clinical infection and sepsis can critically threaten these patients with VADs. Infection can delay immediate transplantation and potentially require the removal of the device for definitive treatment of the problem. Methods: Patients who underwent insertion of a ventricular assist device at the University of Pittsburgh Medical Center (UPMC) were identified through accessing the medical records archives of the hospital. Chart reviews were conducted to obtain patient demographics, pre-operative diagnosis and disease state, type of VAD inserted, post-operative day (POD) of VAD infection onset, infectious organism identified, timing of omental flap procedure after initial VAD insertion operation, duration of VAD support prior to cardiac transplantation, and patient follow-up. Results: There were 38 patients who underwent a VAD insertion procedure during the four-year period between January 2000 and January 2004. Of the 38 patients who received a VAD, 11 patients (29% of patients) had evidence of clinical infection secondary to VAD insertion. Two of these 11 patients expired prior to surgical intervention, four had their VADs explanted, and the remaining five patients underwent omental flap transposition with bilateral pectoralis major advancement flaps in surgically addressing their VAD infections. Post-operative onset of VAD infections ranged from POD 9 to POD 64 (mean POD 26.6). Timing of omental flap procedure after onset of VAD infection ranged from 2 to 11 days (mean 5.4 days) after initial onset of VAD infection. Total duration of ventricular support ranged from 90 to 348 days (mean 184.8 days); with duration of ventricular support status post omental transposition flap procedure ranging from 19 to 326 days (mean 152.8 days). Of the five patients with VAD infections who received omental transposition flaps, two went on to become successfully transplanted, two continue to await cardiac allograft transplant, and one expired of an unknown cause. Conclusions: We present our experience for five patients that received omental transposition flaps to cover infected VAD pumps and the associated tubing in large open sterno-abdominal wounds. Treatment included the direct application of an omental transposition flap over the infected VAD with use of a bilateral pectoralis advancement flap to aid in complete sternal and skin closure of the sternal wound defect. In each of these cases, the use of the omental flap was followed by resolution of the mediastinal infection. In addition, the treatment with an omental flap prevented the removal of infected VADs in patients who were otherwise pump dependent during their waiting periods for a transplant. The use of omental transposition flaps can be an effective technique in salvaging infected VADs and preserving this valuable device for patients awaiting a cardiac transplant.