We report a patient with necrotizing mediastinitis complicated by a giant retrosternal mycotic pseudoaneurysm and prosthetic valve endocarditis successfully managed with a redo sternotomy under hypothermic circulatory arrest. The approach then included extensive débridement of the mediastinum, replacement of the ascending aorta and aortic arch with selective antegrade cerebral perfusion, redo aortic valve replacement, and wound closure with omental flap and myocutaneous flap. After a 2-year survival, the patient suffered reinfection from hemodialysis. Our approach is also applicable to more common presentations of mediastinitis.
Chevalier, A. T., Khaja, M. S., & Yang, B. (2016). Surgical Management of Necrotizing Mediastinitis With Large Aortic Pseudoaneurysm. Annals of Thoracic Surgery, 101(5), e143–e145. https://doi.org/10.1016/j.athoracsur.2015.10.022