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. Elevated white blood cells, anemia, and neutrophilia. Further studies revealed gram-positive cocci on the initial blood culture, which was then confirmed to be Methicillin Sensitive Staph Aureus bacteremia. Subsequently, a transesophageal echocardiography showed a periaortic abscess, moderate aortic regurgitation and severe aortic stenosis 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 transcatheter aortic valve replacement. Postoperatively, the complications included bradycardia, and right heart failure. Six-week course of IV Rifampin, Probenecid, and Cefazolin was initiated, and patient was to remain on lifelong Cefadroxil. A hybrid approach should be considered for patients with high morality risks in the field of cardiovascular medicine as it offers the best available combination of treatments.