[Infected false aneurysm due to methicillin-resistant staphylococcus aureus after proximal aortic grafting]

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.