Greater Omentum Wrapping to Treat Systemic Ventricular Assist Device Infections

Abstract

Because of the decreasing availability of donor hearts and the simultaneous increase in patients with terminal heart failure, the implantation of a left ventricular assist device has become the only reasonable alternative to heart transplantation. The systems themselves have undergone considerable development and corresponding miniaturization. The so-called driveline, the cable that exits the body via the abdominal wall and connects the pump to the control unit and power supply, continues to represent a weak point in the system. As a foreign body, the driveline provides an ideal entry port for germs. All along the driveline, infections can develop with subsequent sepsis, affecting the entire pump. Deep infections spreading via the driveline are one of the greatest problems surrounding left ventricular assist device therapy. Exchanging the pump is frequently the only option, leading to significant morbidity. Transposition of the greater omentum in cardiothoracic surgery has proven beneficial in the management of complex, infected wounds and their cleaning. This paper describes the surgical procedure of omentoplasty to clean up driveline infections.