Massive prosthetic aortic abscess: an overarching plight 7 years post-Bentall's procedure

Abstract

Infections of proximal aortic vascular grafts are a catastrophic complication of aortic surgery. Despite aggressive antimicrobial and surgical intervention, mortality and reinfection rates remain significant. Here, we describe a man aged 71 years with a medical history of bioprosthetic aortic valve with aortic arch replacement (modified Bentall's procedure), who developed a large periprosthetic abscess due to Staphylococcus aureus 7 years after his initial surgery. The patient's preference was to avoid redo surgery, however despite high-dose intravenous flucloxacillin and oral rifampicin therapy, there was rapid progression of the abscess, necessitating urgent surgery. Notwithstanding the burden of infection, the patient underwent successful surgical excision and graft re-implantation and remains independent and well, almost 2 years postoperatively.

Keywords: cardiothoracic surgery; infections.

Figure 1

Admission chest X-ray showing a widened mediastinum projecting into right hemithorax.

Figure 2

Emergency department CT angiogram (left) and follow-up CT 1 week later (right) showing abscess enlargement and emergence of gas locules. A: ascending aorta, B: main pulmonary artery, C: abscess cavity, arrows; gas locules.

Figure 3

Positron emission tomography imaging illustrating an intensely fludeoxyglucose (FDG) avid collection around the ascending aorta and aortic root. A: ascending aorta, B: main pulmonary artery, arrows; FDG avid components of abscess.