High-pressure irrigation and gentian-violet application for mediastinitis following replacement of ascending aorta and aortic valve.

Mediastinitis following ascending aortic replacement is intractable and potentially fatal, and the feature is characterized as having both high mortality and morbidity when its causation pathology is methicillin-resistant Staphylococcus aureus (MRSA). Possible treatments for the condition, which include debridement, irrigation, and healthy tissue transposition, often result in failure. We report a case of MRSA mediastinitis after replacement of the ascending aorta and the aortic valve successfully treated by continuous saline lavage and drainage, debridement, high-pressure irrigation, and gentian-violet application, and delayed omental-flap transposition. The application of gentian violet and high-pressure irrigation may provide an additional option to the standard therapy for intractable mediastinitis after ascending aortic replacement.