Open Repair of Aortic Arch Mycotic Pseudoaneurysms With Distal Perfusion

An 80-year-old man presented with a fast expanding 9.5-cm mycotic arch pseudoaneurysm. The right axillary and femoral arteries were cannulated. Through sternotomy, a reverse zone 2 arch replacement was performed with a 28-mm rifampin-soaked Hemashield aortic graft (Maquet, Wayne, NJ) graft with circulatory arrest. A 30-mm Coda balloon (Cook Medical, Bloomington, IN) was used to occlude the descending aorta, and the lower body was perfused through the femoral artery. The infected pseudoaneurysm was debrided and irrigated. A separate 28-mm rifampin-soaked Dacron graft was anastomosed to the proximal-descending aorta. The left subclavian artery was anastomosed to the proximal Dacron graft. Finally, the proximal and distal Dacron grafts were anastomosed together. (c) 2022 by The Society of Thoracic Surgeons