Treatment of postoperative infection of ascending aorta and transverse aortic arch, including use of viable omentum and muscle flaps

A Case of an Aortic Abscess around the Elephant Trunk

“…In 1984, Hargrove et al 12) reported successful infection control by omental filling without removal of infected prosthetic grafts. The results of a similar approach reported by Coselli et al 1,3,13) were favorable, as represented by an 88% early survival rate and no recurrence. Nakajima et al 14) took the same approach using povidone iodine packing and reported both a 100% survival rate and a 100% recurrence prevention rate.…”

“…Some of these early-onset cases, however, have only slight increases in white blood cell count and CRP, and no symptoms. 1,[3][4][5][6] Late prosthetic graft infection may occur 20 years postoperatively or later; in these late-onset cases, SSI is unlikely to be involved in the mechanism of development. 4) Shiono et al 7) studied the relationship between periodontal disease and infectious endocarditis and reported that oral pathogenic bacteria causing oral lesions were also detected from cardiac valve tissues, vegetation, and blood at a high frequency.…”

“…10) It is expected that bacterial identification will be performed using metagenome analysis in the future. 11) For the treatment of prosthetic vascular graft infection in the thoracic aortic area, Coselli et al 1) reported a composite of aortic graft reconstruction and omental filling procedures after re-thoracotomy and debridement in 1999, resulting in a high 1-year mortality rate of approximately 30%. In 1984, Hargrove et al 12) reported successful infection control by omental filling without removal of infected prosthetic grafts.…”

“…1) In most cases, an abscess forms around the vascular prosthesis. Treatment included vascular graft replacement as an invasive procedure after removal of infected tissues and debridement.…”

Surgical treatment of infective prosthetic endocarditis of ascending aorta with aorto-pulmonary fistula and ascending aortic giant aneurysm after previous Bentall-DeBono procedure

“…Однако сочетание антибактериальной терапии и экстренного хирургического лечения достоверно снизило в последнее время летальность до 8-25%, а 5-и 10-летняя выживаемость после повторных операций составляет 50-80% [1,3,7,10,16]. Основными причинами летальности являются кардиогенный шок, отек легких, полиорганная недостаточность, эмболические осложнения.…”