Abstract 13814: Combined Omental and Bilateral Pectoralis Major Flaps for Treatment of Thoracic Aortic Graft Infections

Abstract

Introduction: Aortic graft infections have historically been managed through graft removal and replacement. However, coverage with vascularized tissue flaps may provide an effective alternative, particularly in patients who are not able to undergo extended extra-anatomic bypass procedures. Hypothesis: Here we describe our experience treating thoracic aortic graft infections with combined omental and bilateral pectoralis major myocutaneous (PMM) advancement flaps. Methods: All patients undergoing sternal wound treatment with PMM flaps by the senior author (JAA) at a high-volume cardiac surgery center from 1996-2023 were reviewed. Patients with evidence of aortic graft infection were included. Results: Complete data were available for 598 patients, 11 of whom had combined PMM and omental flaps mobilized for aortic graft infections. ASA score was >4 in 9/11 (81.9%). At the index cardiac surgery, 11/11 (100%) underwent aortic root repair/replacement, and 9/11 (81.9%) also underwent aortic valve repair/replacement. Indications in this group for flap surgery included culture-positive infection (8/11; 72.7%), dehiscence (5/11; 45.5%), drainage (7/11; 63.6%), and inability to close the sternotomy incision due to hemodynamic instability (5/11; 45.5%). During chest exploration, 7/11 (63.6%) underwent complete removal of the infected graft, compared to 4/11 (36.4%) who underwent graft-preserving washout and debridement. Immediate flap closure was performed in 4/11 (36.4%). Intraoperative mediastinal cultures were positive in 3/11 (27.3%). Post-operative complications included dehiscence (1/11; 9.1%), seroma (2/11; 18.2%), hematoma (1/11, 9.1%), abdominal hernia (1/11; 9.1%), and recurrent infection (1/11; 9.1%). One (9.1%) patient died within 30 days of sternal reconstruction from mitral valve failure and a tachyarrhythmia. None have undergone reoperation for flap-related complications, while one patient underwent elective resection due to aesthetic complaints. Conclusions: Low postoperative morbidity and mortality indicate that combined omental and pectoralis major flaps are a safe and effective treatment for aortic graft infections.