Repeated prosthetics of the ascending aorta and aortic arch with a homograft for prosthesis infection and ruptured aorta after Bentalla de Bono operation

Abstract

Prosthetic vascular graft infection is a formidable complication after cardiac surgery. Until now, the question on the tactics of managing such patients remains open, as well as the timing of each of the treatment methods such as conservative antibiotic therapy and surgery. In addition, the choice of a method of surgical treatment in itself poses new questions for specialists in regard to what methods to adhere to including prosthesis-preserving technique, prosthesis explantation and its replacement with a synthetic or biological graft, and the use of omentum to cover the infected bed. We present a case of treating a patient with an infected synthetic valve-containing conduit after Bentall de Bono operation and aortic rupture with the formation of false aneurysms. Attention is drawn to the prolonged clinical patient condition manifesting with fever, and the lack of data suggesting an infectious process according to positron-emission tomography and blood cultures. We chose a homograft of the ascending aortic and aortic arch with aortic valve as a conduit. It is also of interest that cultures of infectious prosthesis and aortic valve did not reveal any infectious agent. Aggressive antibiotic therapy in combination with surgical replacement of the infected prosthesis with a cryoprepared allograft allowed for successful treatment of patient without complications.