Giant ascending aortic pseudoaneurysm requiring third re-do sternotomy more than two decades after aortic root replacement in an octogenarian: a case report.

Ascending aortic pseudoaneurysm (AAP) is a rare but potentially fatal late complication of cardiac and aortic surgery. Surgical repair becomes particularly challenging when the lesion is large, adherent to the posterior table of the sternum, and encountered during repeat sternotomy. We report the successful management of an 11-cm AAP arising from distal graft dehiscence more than two decades after mechanical aortic root replacement in an 82-year-old man. Owing to the high risk of catastrophic haemorrhage during re-entry, peripheral cardiopulmonary bypass, profound hypothermia was established before sternotomy. The pseudoaneurysm was successfully resected and reconstructed with extended hemiarch replacement. The patient experienced an uncomplicated recovery and was discharged home on postoperative day seven. This case highlights key technical considerations in the repair of complex ascending aortic pseudoaneurysms.