Open repair of native and prosthetic aortic infection with pre-sutured or stapled xenopericardial grafts

Background: Aortic Graft Infection (AGI) and Infective Native Aortic Aneurysm (INAA) require open repair with infection-resistant prostheses. Physician’s made xeno-pericardial grafts combine availability with freedom from reinfection, but mainly short-term results are reported. The aim is to examine the mid-term outcomes in aortic infections using stapled physician-made or pre-sutured bovine pericardium tube grafts. Methods: We report all patients who underwent in situ aortic reconstruction using pericardial tube grafts (prepared from pericardial patches using a surgical stapler or pre-sutured) for AGI or INAA between January 2019 and October 2024 at a single center. Perioperative outcomes and follow-up data were retrospectively collected. Results: Twenty-one patients (18 male, median age 72 years) underwent aortic surgery and implantation of a preformed (N.=5) or stapled physician-made (N.=16) pericardial tubes graft for an INAA (N.=7) or AGI (N.=14). All AGI patients had late infections (median time from primary surgery of 81 months), in nine cases associated with aorto-digestive fistula. One perioperative death was recorded. Patients treated for an AGI demonstrated a longer median length of stay (22 vs. 12 days; P=0.020) and higher intraoperative blood loss (1400 vs. 400 mL; P=0.025). Of the 20 patients surviving the index event, at a mean follow-up of 23±8 months, no aortic-related death, nor mechanical failure were recorded. One case of reinfection and reintervention has been observed (4.8%). All but one patient discontinued the antibiotic therapy after a median duration of 146 days. Conclusions: Aortic repair with preformed and home-made stapled xeno-pericardial grafts is safe and provides durable infection-free survival at a mid-term follow-up.