Cardiac Reoperation in a patient who previously underwent omentoplasty for postoperative mediastinitis: a case report

Sternal infection has been a challenging problem with high mortality and morbidity rates since the introduction of sternotomy in 1957 [1]. Mediastinitis after cardiac surgery is still an important complication associated with significant morbidity and mortality [2,3]. Mediastinal and sternal infection rates range from 0.4% to 5%.As the subsequent septicemia and sepsis targeting the heart, the sutures lines and prosthetic conduits or valves can be life-threatening; a rapid and effective treatment is required to avoid high mortality in these patients. Optimal treatment for poststernotomy mediastinitis remains controversial.In this study, we present the cardiac reoperation of a 52 year old man with corrected transposition of great arteries (c-TGA) who had undergone a previous omentoplasty for postoperative mediastinitis.A 52 year old man was admitted to our clinic with shortness of breath and tachycardia. His past medical history included replacement of the mitral valve (biprosthesis 29 Sorin) and interposition of a valved conduit (25 mm Shelhigh) between the left ventricle and the pulmonary artery with a diagnosis of c-TGA, right atrioventricular valve (AV) insufficiency and pulmonary stenosis two years prior to presentation. His postoperative course was complicated by mediastinitis (blood cultures and exudate of the surgical wound were positive for methicillin-resistant Staphylococcus aureus), which required long-term antibiotic treatment and debridement of necrotic sternal fragments without success. Eventually, an omentoplasty (release of the greater omentum, sparing both vascular pedicles and short gastric vessels, with tunneling to the anterior mediastinum via upper midline laparotomy) was performed, sternum was closed with Robicsek type closure and the wound with a subcutaneous tissue and skin. The patient was discharged one month after the surgery. Upon presentation, his physical examination revealed a high grade systolic murmur at the right upper sternal border