Successful surgical in situ treatment of prosthetic graft infection by staged procedure after Bentall operation and total aortic arch replacement

Abstract

We report a case of a 29-year-old Marfan patient who developed prosthetic graft infection 10 months after Bentall operation and successive replacement of the remaining ascending aorta and the entire aortic arch for acute aortic dissection. Instead of an aggressive high-risk aortic redo procedure with removal and replacement of the infected prosthetic graft we elected a staged graft-sparing surgical approach. After 18 months of close follow-up the patient is in good condition and free from infectious sequela. This case and our review of the literature suggest that open extensive disinfection followed by tissue flap coverage is highly effective in controlling thoracic aortic prosthetic graft infection and may be considered as first-line treatment in such high-risk aortic arch redo patients.

Secondary Aortoenteric Erosion Followed by Recurrent Lower Extremity Abscesses

“…Furthermore, the omentum has been used for a vari et y of surgical procedures (34). It can prevent or control aortic graft infection (35), and has been described as an ideal biological drain (30). Our case had a rich and vascularized greater omentum, and the infection was localized .…”

“…Moreover, cryopreserved allograft may not be available for such urgent operations , and it is expensive. Conversel y, in situ graft-preserving strategies have also been reported (29)(30)(31)(32)(33). Previous reports have described either a prolonged period of irrigation with povidone-iodine, or intermittent packing with povidone -iodine-soaked sponges (32,33).…”

The “3M” Approach to Cardiovascular Infections: Multimodality, Multitracers, and Multidisciplinary

“…TEE plays a key role in the assessment of IE, but is not always conclusive due to the numerous artifacts related to the presence of the prosthesis. In most of the published reports, the diagnosis of infection in composite aortic grafts needs a combination of TTE, TEE, CT and PET/CT (175,178,(182)(183)(184).…”

Surgical treatment of aortic graft infections

“…В большинстве случаев можно сохранить инфицированный протез аорты путем агрессивной хирургической обработки, ирригации раны антибиотиками и покрытием инфицированных сосудистых материалов васкуляризированными аутотканями (сальник, мышечный лоскут) [8]. При этом одни исследователи придерживаются тактики одномо-ментного вмешательства, докладывая о ранней выживаемости 88 и 100% свободе от повторного вмешательства [8], другие считают целесообразным этапный подход [20,21].…”

“…Авторы докладывают о 100% выживаемости и отсутствии рецидивов ИПА. Этот метод нашел применение в дальнейшем и у других авторов [21].…”