Successful drainage of periaortic graft abscess and transcatheter aortic
valve replacement in the same setting - a hybrid approach.
Abstract
81-year-old man with a history of Bio-Bentall surgery presented to the
emergency department with fever, chills and back pain. Initial physical
examination was inconclusive apart from sudden onset of delirium, and
investigation showed elevated WBCs, anemia, and neutrophilia. Further
studies revealed gram-positive cocci on the initial blood culture, which
was then confirmed to be MSSA bacteremia. Subsequently, a TEE showed a
peri-aortic abscess, Moderate AR and severe AS with no evidence of
endocarditis. Antibiotics were started and urgent abscess drainage was
planned. In a hybrid operative setting, a multidisciplinary team of
cardiology, and cardiac surgery managed the periaortic graft abscess
drainage through a median sternotomy and TAVR. Post-operatively, the
complications included bradycardia, and RHF. Six-week course of IV
Rifampin, Probenecid and Cefazolin was initiated, and patient was to
remain on lifelong Cefadroxil.