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DOI: 10.1055/s-0043-1761721
Transposition of the Greater Omentum into the Mediastinum for Treatment of Infected Prosthetic Grafts of the Ascending Aorta and Aortic Arch
Background: Prosthetic graft infection of the ascending aorta and aortic arch requires in situ reconstruction due to close location to the heart. Transposition of the greater omentum into the mediastinum and coverage of the new graft with the omentum is an additional measure to protect the suture line from reinfection by enhancing microbiological resistance. In high-risk patients it may be a solely surgical treatment as a palliative therapy by wrapping the old, infected prosthetic graft. This surgical procedure is barely performed for the treatment of infected aortic graft prostheses.
Method: In total 30 patients with prosthetic graft infection of the ascending aorta and/or aortic arch received transposition of the greater omentum into the mediastinum from 2000 to 2022 at our institution. Transposition of the greater omentum into the mediastinum was performed as an additional therapy after replacement of the infected graft (“radical group,” n = 9) or solely palliative therapy by wrapping the old, infected graft (“palliative group,” n = 21).
Results: In-hospital and 1 year mortality were both 0% (n = 0) in the “radical group” and 14% (n = 3) and 45% (n = 9) in the “palliative group,” respectively. Freedom from infection at the time of discharge could be reached in every patient in the “radical group” and in 52% (n = 11) in the “palliative group.” Long-term survival was 6.4 years (median = 2.3 years) in the “radical group” and 3.0 years (median = 1.9 years) in the “palliative” group. Follow-up reached up to 16 years depending on the operation date.
Conclusion: Transposition of the greater omentum and wrapping of the prosthetic graft may improve outcome treating aortic graft infection, but the mortality remains still high. Long-term follow-up for freedom from infection is needed to evaluate the sustainable efficacy of this surgical strategy.
Publication History
Article published online:
28 January 2023
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