Outcomes Following Use of Bovine Pericardium (Xenoprosthetic) Grafts for Reconstruction of Mycotic Aortic Aneurysms and Infected Aortic Grafts: A Systematic Review and Meta-Analysis

Abstract

ObjectiveInfected aortic grafts and mycotic aneurysms represent one of the most complex challenges faced by vascular surgeons. Treatment has progressed from extra-anatomical bypass to in-situ reconstruction. Additionally, Bovine pericardium reconstruction (BPR) has increased, due to accessibility and reduced lower limb morbidity. There remains, however, limited evidence for its use. The aim is to pool all known data to understand outcomes following BPR of mycotic aneurysms or infected vascular grafts. Methods and materialsA systematic review was conducted in November 2021 with subsequent computerised meta-analysis of the pooled results and a final search in March 2022.Three databases (EMBASE, CINAHL and PUBMED) were searched for the search term “(bovine OR xenoprosthetic) AND (aneurysm)”, according to PRISMA guidelines. ResultsFrom nine studies, there were 133 patients: 67% graft infections; 33% mycotic aneurysms. 57% of reconstructions were in the abdominal aorta and 33% were in the thoracic aorta. 158 pathogens were identified, including Staphylococcus aureus (23%), Candida albicans (13%) and Escherichia coli (13%). In 12%, no microorganisms were identified.30-day mortality was 19.14% (CI 10.83-28.71), late mortality was 19.08% (CI 7.76-32.83) and overall mortality was 40.20% (CI 29.82-50.97). One patient died intra-operatively.There were a total of 151 in-hospital complications after 30-days post-operation. Common complications were acute renal failure (17%), pneumonia (14%), delirium (12%), respiratory insufficiency (11%) and renal insufficiency (7%). Lower limb ischaemia was low, occurring in 5.66% (CI 0.54-13.82) of patients. Loss of graft patency leading to reintervention occurred in 1.20% (CI 0.00-7.71) of the grafts. Reinfection rate was 0.00% (CI 0.00-1.21). ConclusionThis meta-analysis highlights low reinfection and high graft patency using BPR with medium-length follow-up, however, there remains limited long-term and comparative data regarding options for aortic reconstruction. As expected in this complex cohort, the complication rate and 30-day mortality remain high.