Open Approach of Ascending Aorta Septic Rupture.

BACKGROUND

Septic pseudoaneurysms of the native ascending aorta are rare and challenging to treat, especially in elderly, comorbid patients with septic conditions and unfavorable anatomy for endovascular repair.

CASE SUMMARY: A 78-year-old man with prior tricuspid valve replacement for endocarditis presented with methicillin-sensitive Staphylococcus aureus bacteremia. Imaging showed a large ascending aorta pseudoaneurysm, likely at the previous cardioplegia site. He underwent successful surgical repair via direct bovine pericardial patch closure under normothermic cardiopulmonary bypass. Recovery was uneventful.

DISCUSSION: Endovascular repair requires suitable anatomy, including adequate landing zones and small neck size, which were lacking here. Direct surgical patch repair offers a safe, effective, and less-invasive alternative to full aortic replacement, especially in septic, frail patients.

TAKE-HOME MESSAGES: Multidisciplinary heart team discussion is essential to tailor management for complex septic aortic pseudoaneurysms. When endovascular treatment is unfeasible, direct surgical patch repair remains a safe and effective option in selected patients.