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[Infected false aneurysm due to methicillin-resistant staphylococcus aureus after proximal aortic grafting]
K Matsuzaki1, N Shiiya, T Kunihara
1Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Abstract:
A 70-year-old man developed meticillin-resistant staphylococcus aureus (MRSA) mediastinitis after prosthetic graft replacement of the ascending aorta. The sternal wound was reexplored and a single-stage procedure of irrigation, debridement, and omental transposition was performed. Ten months after the first operation, he suffered recurrence of pyrexia and the presence of false aneurysm originated from the distal suture line was diagnosed by the chest computed tomography (CT) scan. Re-replacement of the ascending aorta and proximal hemiarch with rifampicin soaked Gelseal was successfully performed. Hypothermic perfusion with circulatory arrest through peripheral cannulation and left ventricular venting via a left anterior thoracotomy was useful to obtain safe reentry in the operation of retrosternal false aneurysm.
Insights
A 70-year-old man experienced a recurrent methicillin-resistant Staphylococcus aureus (MRSA) mediastinitis after aortic graft surgery. A second surgery successfully replaced the graft, demonstrating a viable treatment for complex aortic infections.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Medical Device Infections
Background:
- Prosthetic graft replacement of the ascending aorta is a critical procedure for aortic diseases.
- Mediastinitis, particularly from methicillin-resistant Staphylococcus aureus (MRSA), poses a significant challenge post-operatively.
- Recurrence of infection and complications like false aneurysms require advanced surgical strategies.
Observation:
- A 70-year-old male patient developed MRSA mediastinitis following ascending aorta prosthetic graft replacement.
- Initial treatment involved sternal wound reexploration with irrigation, debridement, and omental transposition.
- Ten months later, the patient presented with recurrent fever and a diagnosed false aneurysm at the distal suture line via CT scan.
Findings:
- A successful re-replacement of the ascending aorta and proximal hemiarch was performed using a rifampicin-soaked Gelseal graft.
- The complex reoperation utilized hypothermic perfusion with circulatory arrest via peripheral cannulation.
- Left ventricular venting through a left anterior thoracotomy facilitated safe reentry for managing the retrosternal false aneurysm.
Implications:
- This case highlights the successful management of recurrent MRSA mediastinitis and prosthetic graft complications.
- The described surgical technique, including hypothermic circulatory arrest and specialized graft material, offers a potential solution for complex aortic reconstructions.
- Effective treatment strategies are crucial for improving outcomes in patients with challenging post-surgical aortic infections.