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Poststernotomy mediastinitis – our 10 year experience with omentum flap surgery
Session:
Posters (Sessão 1 - Écran 5) - Doença Vascular e Cirurgia Cardíaca
Speaker:
Hagen Kahlbau
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.11 Cardiovascular Surgery - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Hagen Kahlbau; Valdemar Gomes; Luís Miranda; Pedro Félix; Helena Antunes; Manuela Silva; Pedro Coelho; José Fragata
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: The management of postoperative mediastinitis remains challenging. Due to the severity of infection and patient’s individual comorbidities, the optimal treatment is highly variable and multiple operations are usually performed. Vacuum assisted therapy combined with systemic antibiotics are used frequently with good results upon any sign of sternal wound infection. However, when deep sternal wound infection or persistent infections are present, more radical surgical options are necessary.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim</strong>: Based on the literature, we developed an algorithm for patients with mediastinitis with an emphasis on the treatment with an omentum flap, which was used in early postoperative or in late infections when a large defect was present (Figure 1).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: From January 2012 until December 2021, a total of 28 patients (5 female/23 male), 0.4% of our total sternotomy population, were treated according to the departments algorithm with an omentum flap. We retrospectively analyzed preoperative patient´s risk profile, intraoperative data, clinical presentation with laboratory, microbiological and imaging data.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: Mean age was 67,3 years (51–82 years). The majority of patients (13 patients, 46%) underwent coronary artery bypass grafting (CABG), 8 patients valve surgeries, 5 combined CABG and valve surgery and 2 cardiac transplants. Median EuroScore 2 was 2,85% (0,55% - 16,06%) and median STS Score Mortality was 1,47% (0,22% - 5,56%). Median STS risk for deep sternal wound infection was low with 0,17% (0,07% - 0,49%). Relevant risk factors for infection included previous diabetes (57%), history of smoking (46%), hospitalization before surgery (36%), obesity (BMI > 32 kg/m², 25%) and chronic obstructive lung disease (18%). Reoperation for mediastinitis was performed an average of 16 days (range 6–44 days) after initial operation. We performed the omentoplasty through a laparotomy, a secondary pectoralis muscle flap was necessary in 8 patients to achieve skin closure. Two patients required titanium plates in order to stabilize the sternum. In-hospital mortality was 21% (6 patients). Late epigastric hernia occurred in three patients. We did not observe early or late omentum flap failures.</span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">: In our center, omentum flaps for mediastinitis are used for the severest patient group in a standardized fashion with good clinical outcome.</span></span></p>
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