Complex Aortic Graft Infection with Giant Collection after Bentall-Bono Surgery

BACKGROUND: Aortic graft infection (AGI) is a rare but life-threatening complication after aortic root surgery, particularly when postoperative collections are present. CASE SUMMARY: A 49-year-old man developed progressive perigraft enlargement followed by fever and chest pain 8 months after Bentall-Bono surgery. He had recently undergone a dental procedure without antibiotic prophylaxis. Blood cultures grew Enterococcus faecalis, and transesophageal echocardiography revealed a heterogeneous perigraft collection with communication to the aortic lumen, as well as graft vegetations and partial suture dehiscence. These findings fulfilled the Management of Aortic Graft Infection Collaboration criteria for AGI. The patient underwent urgent graft replacement using a hemi-Cabrol technique, with an uncomplicated postoperative course. DISCUSSION: This case illustrates the diagnostic complexity of AGI in patients with altered postsurgical anatomy, where distinguishing infection from chronic collections is challenging. It highlights the pivotal role of multimodality imaging and coordinated multidisciplinary management. TAKE-HOME MESSAGE: Early recognition and timely surgical intervention are essential to improving outcomes in AGI.