1Deutsches Herzzentrum der Charite (DHZC) Klinik für Herz-, Thorax- und Gefäßchirurgie Berlin, Deutschland
Introduction: Prosthetic aortic graft infection of the thoracic aorta is a devastating complication and associated with high mortality. Transposition of the greater omentum into the mediastinum to cover the aortic graft may be an effective supportive treatment method after graft replacement and additional adequate antibiotic treatment.
Methods: We report the case of a 69 year old male patient presenting with aortic graft infection after receiving total aortic arch replacement due to acute type A aortic dissection four years ago. We performed complete replacement of the aortic arch and supra-aortic vessels using a handmade bovine pericardial prosthesis. Then, mediastinal transposition of the greater omentum to wrap the aortic graft and contain the infection was performed.
Results: The patient recovered uneventfully after the operation in the further course, no omentum transposition related complications could be observed. Staphylococcus lugdunensis could be identified as pathogen and was treated by an additional specific antibiotic regiment. During regularly postoperative follow-up over 4.5 years, no clinical and radiological CT-based signs for aortic graft reinfection were observed.
Discussion: Transposition of the omentum and wrapping of the aortic graft is an effective supportive measurement for radical treatment of aortic graft infections. We encourage the decision for this procedure, highlighting the importance for an interdisciplinary approach with plastic and/or abdominal surgeons as well as infectiologists to ensure an effective treatment of aortic graft infection and prevent reinfection.