Related Experiment Video
Updated: May 7, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Complete graft dehiscence 8 months after repair of acute type A aortic dissection
Cathérine Gebhard1, Patric Biaggi, Barbara E Stähli
1University Hospital Zurich, Zurich, Switzerland ; Montreal Heart Institute, Montreal, Canada.
Abstract:
Acute type A aortic dissection is a dreaded differential diagnosis of acute chest pain. Long-term outcome mainly depends on pre-existing comorbidities and post-operative complications. We present a patient with aortic graft dehiscence and subsequent severe aortic regurgitation due to fungal graft infection 8 months after repair of acute type A aortic dissection. Redo aortic surgery had to be delayed for 28 days due to intracerebral haemorrhage caused by septic embolism and clipping of a mycotic left middle cerebral artery aneurysm. Surgery revealed a circumferentially detached graft at the site of the proximal anastomosis thereby forming a massive pseudoaneurysm. The patient underwent successful aortic root replacement using a Freestyle porcine root bioprosthesis (25 mm), followed by re-anastomosis of the coronary arteries and partial replacement of the ascending aorta with a 28 mm Dacron graft. The patient was discharged on day 67 in stable cardiac condition with persistent neurological deficits. This case highlights the challenging management of patients with aortic graft infection and neurological dysfunction after redissection of the ascending aorta who require redo cardiac surgery.
Insights
This case study details a patient experiencing aortic graft dehiscence and fungal infection after acute type A aortic dissection repair. Management involved complex redo aortic surgery complicated by neurological events.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Neurological Surgery
Background:
- Acute type A aortic dissection requires complex surgical repair, with long-term outcomes influenced by comorbidities and complications.
- Aortic graft infection is a rare but serious complication following aortic dissection repair, potentially leading to graft dehiscence and severe aortic regurgitation.
- Neurological complications, such as septic embolism and mycotic aneurysms, can significantly complicate management and delay necessary interventions.
Purpose of the Study:
- To present a challenging case of fungal aortic graft infection and dehiscence 8 months after acute type A aortic dissection repair.
- To illustrate the management complexities, including delayed redo aortic surgery due to neurological complications.
- To highlight the successful surgical intervention and patient outcomes in a rare clinical scenario.
Main Methods:
- A patient with a history of acute type A aortic dissection repair presented with symptoms of graft infection and dehiscence.
- Diagnostic workup included imaging to assess the extent of graft involvement and identify complications like pseudoaneurysm formation.
- The patient underwent delayed redo aortic surgery for aortic root replacement and ascending aorta repair, complicated by prior septic embolism and mycotic aneurysm requiring intervention.
Main Results:
- The patient presented with a circumferentially detached aortic graft at the proximal anastomosis, forming a massive pseudoaneurysm.
- Redo aortic surgery was successfully performed, involving aortic root replacement with a bioprosthesis and ascending aorta repair.
- The patient was discharged with persistent neurological deficits but in stable cardiac condition, 67 days post-surgery.
Conclusions:
- Fungal aortic graft infection following acute type A aortic dissection repair presents a significant management challenge.
- Neurological complications, such as septic emboli and mycotic aneurysms, can necessitate delays in critical cardiac surgery.
- Successful redo aortic surgery is feasible but requires careful multidisciplinary management, addressing both cardiovascular and neurological sequelae.
More Related Videos
14:14Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
13:10Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
Published on: April 24, 2017
