Total Thoracic Aortic "Pericardialization" for Multilevel Prosthetic Graft Infection

Prosthetic aortic infection involving composite roots and frozen elephant trunk components presents an extraordinary challenge with high mortality. We present a complex aortic reconstruction using custom bovine pericardial conduits.

A 55-year-old man with a history of a redo Bentall procedure and frozen elephant trunk implantation presented with extensive pan-aortic prosthetic infection, systemic septic emboli, and acute intracranial hemorrhage. Surgery focused on radical debridement and complete extrication of all synthetic material. The aortic root, ascending aorta, arch, and supra-aortic branches were entirely reconstructed using 4 intraoperatively hand-fashioned bovine pericardial tube grafts, creating a classic elephant trunk assembly. The patient was extubated on the day of surgery, discharged on day 7 without neurologic deficits, and remained infection-free at 3 months.

Radical excision and total aortic reconstruction using hand-made bovine pericardial grafts provide a completely biological, infection-resistant alternative for treating these highly complex conditions.