The Use of an Omental Flap in the Management of Complex Thoracic Aortic Infections

Purpose Recurrent valvular endocarditis and thoracic aortic graft infection (TAGI) present complex clinical problems with difficult management options and poor reported outcomes. Omental flap coverage has been described for these infections, but published experience remains limited. The purpose of this study was to describe our institutional experience with staged mediastinal antibiotic irrigation followed by delayed mediastinal omental flap coverage. Methods We performed a retrospective review of a prospectively maintained institutional database. Adult patients treated at a single institution from January 1, 2017, through December 31, 2019, were included if they underwent operative management for recurrent valvular endocarditis and/or TAGI with mediastinal antibiotic irrigation followed by planned, delayed mediastinal omental flap coverage. Patients were excluded if they were managed nonoperatively, underwent surgery without this staged strategy, had isolated superficial sternal wound infection without graft or valvular involvement, or had insufficient documentation to determine 30-day outcomes. Results Seventeen patients were treated with mediastinal antibiotic irrigation followed by delayed omental flap coverage. Thirty-day mortality was 1/17 (5.9%). Major complications within 30 days occurred in 4/17 (23.5%), including renal failure requiring hemodialysis in 2/17 (11.8%), stroke in 1/17 (5.9%), and reoperation for recurrent infection in 1/17 (5.9%). The composite 30-day major adverse event rate, defined as death, stroke, renal failure requiring hemodialysis, or reoperation for recurrent infection, was 5/17 (29.4%). Conclusions In this single-center series, staged mediastinal antibiotic irrigation followed by delayed omental flap coverage was feasible and was associated with acceptable short-term mortality and complication rates. Further study is needed to determine the optimal timing and patient selection criteria for omental flap coverage in this setting.