Vulnerability of an equine pericardial roll graft to Gram-positive cocci after graft replacement for a ruptured infected abdominal aorta.

The research study covers a case of a 77-year-old male patient who underwent a replacement procedure using an equine pericardial roll graft for a ruptured infected abdominal aorta. Despite initial success, postoperative complications associated with a MRSA bacteremia led to infection of the graft tissue and the patient’s subsequent death.

Background and Objective of the Study

• The primary focus of this study is to discuss the vulnerability of an equine pericardial roll (EPR) graft to MRSA infection, following its replacement of a ruptured infected abdominal aorta.

The Patient’s Procedure and Postoperative Condition

• The 77-year-old male patient underwent a successful EPR replacement of his ruptured infected abdominal aorta, along with a concurrent repair of the perforated duodenum.
• However, the patient later suffered circulatory failure due to septic shock as a result of a MRSA infection and gastrointestinal bleeding on the 23rd postoperative day, which eventually led to his demise.

Findings from the Autopsy and Histological Examination

• The autopsy results indicated that there were no ruptures in the EPR graft and no disruptions at the anastomosis, the junction between the replaced graft and the native abdominal aorta.
• Contrarily, the histological examination revealed that Gram-positive cocci, suspected to be MRSA, had colonized and damaged the inner layer of the EPR graft.

Implications of the Study and Conclusion

• This case study implies that EPR grafts’ resistant properties against infections may be compromised under certain conditions, particularly when used for arterial reconstruction.
• In situations where patients are suffering from sustained MRSA bacteremia postoperatively, the EPR graft may not be able to withstand the infection, leading to severe complications or even death.