Acute type A aortic dissection is a catastrophic disease that requires immediate surgical intervention. The main goal of surgery in acute type A aortic dissection is to prevent death from intrapericardial hemorrhage by resecting and replacing the diseased aorta with a graft . Aggressive surgical approach involving extensive resection of dissected aorta for patients with aortic dissection became more popular over the recent years . However, in this case the surgical treatment was deferred, because the adhered gauze compresses was to be suspected infectious process. Moreover, it is well known that infections involving ascending aortic grafts are extremely difficult to eradicate and are frequently lethal . Treatment of this complication remains a challenge for surgeons, and chances of a successful outcome are considered low. Mortality rates range from 25% to 75%, and morbidity in surviving patients is high . Several groups currently favour replacing infected ascending aortic prostheses with cryopreserved aortic homografts [4–7]. Retrospective data have suggested that, compared with using synthetic grafts, using cryopreserved homografts for treating vascular infections is associated with improved outcomes, including better elimination of infection, fewer postoperative complications, and longer disease-related survival . However, one commonly cited disadvantage of using homografts is their predisposition to progressive deterioration and ultimate need for re-replacement [9, 10]. Unfortunately, in many cases, a single homograft will not reach the distal ascending aorta or transverse arch . Extensive aortic replacement can be accomplished by using total arch homografts, but these are rarely available . Another treatment strategy to prevent recurrent infection is using a pedicled omental or muscle flap. Omentum is particularly popular because, in patients who have not had previous abdominal surgery, omentum can be easily accessed by extending the sternotomy incision into the abdomen for a short distance [12–16]. The blood supply to the omentum is preserved by basing the pedicle on the right gastroepiploic artery. In addition to filling dead space, the vascularised omental pedicle improves oxygen supply to the region, enhances immunologic response, increases antibiotic delivery, and absorbs wound secretions that can serve as substrates for bacterial growth [13, 16].
There are, however, many established options for managing the infected graft, but the literature on surgical treatment of ascending aortic graft infection fails to provide even the lowest level of evidence on which to base a concrete recommendation. Otherwise, the patient was not septic on admission. However, at that point of time the intraoperative situation was not clear concerning the potential infection, we decided in this special case to abort the emergency operation.