25.0: Thursday, March 17, 2005

Successful Treatment of Thoracic Aortic Graft Infection with Omental Flap Sternal Reconstruction

Julia Lee, MD and Darl K. Vandevender.

Mediastinitis and infection of thoracic aortic grafts occur infrequently; however, once they occur they are associated with high patient morbidity and mortality. We report our successful experience in the treatment of seven patients who developed severe mediastinal infections after sternotomy with replacement of the ascending aorta.

Once a prosthetic graft infection was suspected, the patient underwent formal operative debridement. Intraoperative cultures were taken. All patients had documented graft infections and were placed on appropriate antibiotic regimens. After one or two debridements, we then performed definitive reconstructive sternal closure with pedicled omental flaps. The omentum was used to wrap the aortic graft as well as to provide coverage for the mediastinal wound. Every patient except one had in-situ preservation of the prosthetic aortic graft.

The infections were controlled in all patients. There were no peri-operative or in-hospital deaths. All patients were discharged either to home or to a nursing facility. The follow-up period ranges from nine months to five years.

In conclusion, we report our series in the treatment of patients with severe mediastinitis and infection of thoracic aortic grafts. Debridement and tissue coverage with an omental flap provided these patients with successful recovery and survival.