Systematic Review and Meta-analysis on the Use of Bovine Pericardium For Aortic Reconstruction Following Infection

Background: Biological grafts are the preferred option for in situ aortic reconstruction following infections, offering good survival and low complications rates. Vein harvesting may be challenging or undoable in emergency setting. Hence, xenogeneic materials, such as bovine grafts, gained popularity due to their availability, biocompatibility, and low reinfection rates despite data on their outcomes remain limited. Methods: A systematic review and metanalysis was conducted following PRISMA and PIO guidelines using PubMed, Scopus, and Web of Science. Two independent reviewers selected studies, extracted data, and assessed quality. A random-effects meta-analysis was done to evaluate survival, patency, and recurrence. Precision was assessed through 95% confidence intervals, and publication bias was examined using funnel plots and Egger's test. The review was registered in PROSPERO (CRD42024629225). Results: Out of 96 papers screened, 15 studies (300 patients, 81.6% males, mean age 70.5 years) were included. The abdominal aorta was the most frequently treated segment (78.6%), followed by the descending thoracic (9%), thoracoabdominal aorta (6.3%) and ascending/arch (6%). Gram-positive bacteria were the most common pathogens (34.6%) encountered, followed by gram-negative (19%) and fungal infections (10%). Bovine pericardium in situ reconstruction was associated with a 30-day mortality rate of 19.8% (95% CI: 15.0%-25.7%), and a overall mortality of 30.5% (95% CI: 24.2%-37.6%). At a mean follow-up of 18.7 months, reinfection rate was 8.9% and patency rate 92.9%. Conclusion: Bovine grafts show promising mid-term results in treatment of aortic infections, assuring good survival and low recurrence rates at the mid-term follow-up. Long-term data and comparative studies are needed to confirm their broader applicability.