Aortic Perigraft Seroma Following Total Arch Replacement

Abstract

Perigraft seromas (PGS) are a rare but important complication following aortic surgery. This study presents experience of a proximal aortic PGS in a young male following a fourth redo cardiac surgery, and reviewed the published literature on the management of proximal aortic PGS. A case report and review of all published cases of proximal aortic PGS. A 25-year-old male with Marfan syndrome underwent a fourth redo cardiac surgery for completion of a total arch replacement via a clamshell thoracotomy. A mediastinal fluid collection around the distal aspect of the aortic graft was first noted 6 months postoperatively on a computed tomogram angiogram. Extensive investigations including a diagnostic aspirate were performed to determine the aetiology of the collection. Although initially asymptomatic, the patient became symptomatic 6 years postoperatively, with the collection measuring 115mm x 93mm x 110 mm. He underwent an exploratory left anterior mediastinotomy, where the diagnosis of a PGS was confirmed. Reports of PGS complicating proximal aortic grafts are exceedingly rare, with four other cases described in the literature. It is believed that this is the largest reported proximal aortic PGS, and the only case where intervention was performed via a mediastinotomy. Proximal aortic perigraft collections can represent a diagnostic challenge. Stable collections in asymptomatic patients with normal inflammatory markers may be suitable for conservative management with close surveillance. This study presents a guideline for the investigation and management of asymptomatic perigraft collections.