# Complex Aortic Graft Infection with Giant Collection after Bentall-Bono Surgery: Diagnostic and Therapeutic Challenges

## TL;DR

This case study describes a rare and complex aortic graft infection following heart surgery, emphasizing the challenges in diagnosis and the importance of timely treatment.

## Contribution

The paper presents a unique case of AGI with a large collection after Bentall-Bono surgery, highlighting diagnostic and therapeutic challenges.

## Key findings

- The patient's infection was diagnosed using multimodality imaging and blood cultures, revealing a heterogeneous perigraft collection.
- Urgent graft replacement using the hemi-Cabrol technique led to an uncomplicated recovery.
- Early recognition and surgical intervention are critical for improving outcomes in AGI.

## Abstract

Aortic graft infection (AGI) is a rare but life-threatening complication after aortic root surgery, particularly when postoperative collections are present.

A 49-year-old man developed progressive perigraft enlargement followed by fever and chest pain 8 months after Bentall-Bono surgery. He had recently undergone a dental procedure without antibiotic prophylaxis. Blood cultures grew Enterococcus faecalis, and transesophageal echocardiography revealed a heterogeneous perigraft collection with communication to the aortic lumen, as well as graft vegetations and partial suture dehiscence. These findings fulfilled the Management of Aortic Graft Infection Collaboration criteria for AGI. The patient underwent urgent graft replacement using a hemi-Cabrol technique, with an uncomplicated postoperative course.

This case illustrates the diagnostic complexity of AGI in patients with altered postsurgical anatomy, where distinguishing infection from chronic collections is challenging. It highlights the pivotal role of multimodality imaging and coordinated multidisciplinary management.

Early recognition and timely surgical intervention are essential to improving outcomes in AGI.