Abstract
INTRODUCTION: A 66-year-old man with a history of homograft implantation in aortic position 30 years ago, was referred with an actively bleeding sternotomy wound. CASE SUMMARY: Computed tomography revealed perforation of the ascending aorta by the most cranial steel band wire, forming a large pseudoaneurysm. Surgery in deep hypothermic circulatory arrest included wire removal and pseudoaneurysm repair. On the 1st postoperative day (POD), significant mediastinal bleeding required revision surgery, leading to ascending aorta replacement. The patient fully recovered and was discharged on the 33rd POD. POTENTIAL PITFALLS: Conventional resternotomy was deemed too risky, even with cardiopulmonary bypass (CPB) support. Instead, peripheral CPB cannulation, cooling to 18 °C and resternotomy with the patient under circulatory arrest were the method of choice. Left ventricular (LV) venting via a left-side minithoracotomy prevented LV distention, which was critical owing to mild-to-moderate aortic valve incompetence and risk of ventricular tachycardias. TAKE-HOME MESSAGE: Repair of the pseudoaneurysm was achieved safely; however, these procedures should be performed in high-volume centers specialized in aortic surgery.