Treatment For Infected Frozen Elephant Trunk Prosthesis Caused by Propionibacterium acnes: A Surgical Challenge

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Aortic Surgery

Background:

• Complex aortic pathologies necessitate advanced surgical techniques like the Bentall-Bono procedure and frozen elephant trunk (FET) prosthesis.
• Endovascular stent-graft repair is an alternative for descending aorta issues.
• Graft infection is a serious complication following aortic reconstruction.

Purpose of the Study:

• To report a unique case of late-onset graft infection by Propionibacterium acnes after Bentall-Bono and FET implantation.
• To describe the clinical presentation, diagnostic challenges, and management of this rare complication.
• To emphasize the importance of considering graft infection in patients with late complications after aortic surgery.

Main Methods:

• Case report of a 47-year-old male patient.
• Review of medical history including Bentall-Bono procedure, FET prosthesis, and prior endovascular repair.
• Detailed description of diagnostic workup and emergency surgical intervention.

Main Results:

• Development of subacute graft infection by Propionibacterium acnes eight years post-initial surgery.
• Presentation of cardiogenic shock due to severe aortic regurgitation and aortic root dehiscence from pseudoaneurysms.
• Successful emergency surgical management involving graft replacement with a biological valve tube and debranching of supra-aortic vessels.

Conclusions:

• Late graft infection, even with unusual pathogens like Propionibacterium acnes, can occur years after complex aortic surgery.
• Aortic root dehiscence and pseudoaneurysm formation are critical complications of graft infection.
• Aggressive surgical management is crucial for survival in such advanced stages of graft infection.