Distinct Roles of Omental and Latissimus Dorsi Flaps for Blocking Infection Pathways and Protecting A Left Ventricular Assist Device

Abstract

Left ventricular assist devices (LVADs) are vital for managing severe heart failure in transplant-ineligible patients, but device exposure and infection pose significant challenges. This report details a 42-year-old man with dilated cardiomyopathy and bronchial asthma who presented with an externalized LVAD following a HeartMate II to HeartMate III exchange due to malfunction. Our tailored surgical strategy treated the LVAD driveline and main body as two distinct parts. This distinction is crucial, as major upstream infections typically originate from the driveline. We applied flaps to these parts for different purposes, maximizing their unique characteristics. The omental flap, chosen for its flexibility, blood supply, and immunological activation upon foreign body contact, covered the driveline. The latissimus dorsi flap provided vascularity and mechanical protection for the LVAD. Additionally, we review the omentum's basic physiological aspects, which are often unfamiliar to clinicians. Infection has not recurred in 6 months postoperatively, demonstrating the approach's effectiveness.