Outcomes of Native or Graft Abdominal Aortic Infection managed with Orthotopic Xeno Pericardial Grafts or Cryopreserved Allograft: A French bicentric comparative study.

Abstract

Background: The ideal substitute for in situ reconstruction of aortic graft or native aortic infection has yet to be defined. Though recognized as resistant to infection, cryopreserved arterial allograft (Allograft) presents problems of availability when treating emergent cases, with the risk of long-term aneurysmal degeneration. Commercially available bovine pericardial (Pericard) appears as an alternative, with promising results in the recent literature. The goal of this study was to compare the results of these two substitutes.

Material and methods: Between January 2010 and December 2023, we conducted, a retrospective observational study in two tertiary centers, including all patients having undergone in situ surgery for aortic graft or native aortic infections with reconstruction by Allograft or Pericard. Survival, reinterventions and reinfections were analyzed according to the Kaplan-Meier method and Cox regression model.

Results: All in all,169 patients were included in the study with 103 aortic graft infections (60.9%), 33 aortic endograft infections (19.5%) and 33 native aortic infections (19.5%). Allograft was used in 111 patients (65.7%) and Pericard in 58 (34.3%). The two groups were comparable as regards preoperative risk factors, types of index surgery, and infectious agents, with 41 (24.8%) patients with an aortoenteric fistula. There was no significant difference in postoperative complications. Median follow-up was 18 months [IQR: 4-44 months]. At 24 months, survival was comparable, with 68±4% for Allograft and 68±6 for Pericard, as was reinfection-free survival with 80±4% for Allograft versus 83±6% for Pericard (p = .722). Reintervention-free survival at 2 years was likewise comparable: 86±4% for Allograft versus 77±8% for Pericard (p = .419).

Conclusion: A pericardial substitute offers the possibility of in situ aortic reconstruction without problems of availability and with mid-term results comparable to those achieved with aortic allografts. Further studies with long-term follow-up are needed to validate the absence of late reinfection and to confirm pericardial substitute patency.