Poststernotomy mediastinitis treated by transposition of the greater omentum

Due to its anatomical structure and physiological properties, omental tissue has proven to be beneficial when transposed to the thorax to treat severe mediastinal infections. Between April 1987 and July 1994, 17,005 open heart operations were performed at our institution. One hundred and forty patients who developed mediastinitis or serious wound infections postoperatively were treated by transposition of the greater omentum into the retrosternal space. These patients were compared with a control group of 100 patients operated in the same period, who did not develop infectious complications postoperatively. Significant differences were found in several risk factors, such as obesity, type, and duration of primary operation, ejection fraction < 30% (< 0.01), as well as the incidence of low cardiac output syndrome treated by insertion of an intra-aortic balloon pump (p < 0.05). However, no significant differences were observed in factors such as diabetes mellitus, emergency operation, reoperation, degree of postoperative bleeding, and duration of aortic cross-clamp time. The mortality of mediastinitis largely depended on the type of primary operation. It was 19.2% in patients who underwent coronary surgery, and 52.2% in patients who underwent transplantation (overall mortality 35.7%). Only in 2% of the patients did we find complications related to the creation of the omental pedicle and its translocation. Today, serious disturbances in sternal wound healing, especially involving mediastinitis, are rare complications in cardiac surgery. Nevertheless, they continue to be associated with high mortality and prolonged hospitalization.