Endovascular Repair as a Bridge to Open Repair of a Ruptured Descending Thoracic Aspergillus Aortitis

Invasive aspergillosis rarely involves the thoracic aorta and is associated with a poor prognosis. A 56-year-old heart transplant recipient presented with invasive aspergillosis, primary Aspergillus aortitis, and a ruptured thoracic aorta pseudoaneurysm. Open surgical repair was not possible because of severe sepsis. Therefore, a sequential surgical strategy was planned, including emergency thoracic endovascular aortic repair, followed by antifungal treatment and definitive open repair with explantation of the endograft and placement of a cryopreserved arterial allograft under extracorporeal membrane oxygenator support. The infection did not reoccur during follow-up, and the patient remained alive and well 13 months after the operation. (C) 2017 by The Society of Thoracic Surgeons