JACC Case Rep. 2026 Jan 28;31(4):106139. doi: 10.1016/j.jaccas.2025.106139.

ABSTRACT

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.

PMID:41609270 | DOI:10.1016/j.jaccas.2025.106139