Prosthetic infection of the ascending aorta and aortic arch: overview of modern treatment strategies

Authors: Bockeria L.A., Abdulgasanov R.A., Gasymov E.G., Abdulgasanova M.R.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

UDC: 616.132.1-007.21:616.126-022.7
DOI: https://doi.org/10.24022/1810-0694-2022-23-2-169-182

Cite as: Bockeria L.A., Abdulgasanov R.A., Gasymov E.G., Abdulgasanova M.R. Prosthetic infection of the ascending aorta and aortic arch: overview of modern treatment strategies. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2022; 23 (2): 169–82 (in Russ.). DOI: 10.24022/1810-0694-2022-23-2-169-182

Received / Accepted: 05.08.2021 / 06.04.2022

Keywords: prosthetic infection mediastinitis sepsis omentoplasty myoplasty

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Abstract

Prosthetic ascending aortic infection (PAAI) and aortic arc is a rare, but formidable complication, associated with high mortality, and the treatment of which is difficult problem. In severe cases, the development of the wound infection of the chest can occur, accompanied by dehiscence of the sternum, deep wound infection, mediastinitis. At an early stage of infection, clinical symptoms can be erased and nonspecific, which leads to delayed diagnosis and treatment initiation. Replacement of an infected graft is an effective but difficult strategy, especially if the aortic root or arch is involved. An alternative surgical tactics is preservation of the graft in situ, followed by irrigation of the mediastinum after surgical debridement of the wound, which is an effective and safe strategy in case of early diagnosis and initiation of treatment. The article also discusses the role of negative pressure wound treatment, plastic methods for closing chest wall defects using muscle and omental flaps. An integral part of effective PAAI therapy is a properly selected antibiotic therapy, which allows, regardless of the choice of surgical strategy, to improve clinical outcomes.

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About the authors

Leo A. Bockeria, Academician of Russian Academy of Sciences and RAMS, President; ORCID
Ramiz A. Abdulgasanov, Dr. Med. Sci., Chief Researcher; ORCID
Emil’ G. Gasymov, Resident; ORCID
Mekhriban R. Abdulgasanova, Physician-Applicant; ORCID

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Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery

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