Mid-term outcomes of xenopericardial roll graft replacement for thoracic and thoracoabdominal native aortic and prosthetic graft infection: a single-centre retrospective study

OBJECTIVES: This study aimed to evaluate the feasibility and mid-term outcomes of in situ aortic reconstruction using xenopericardial roll grafts for thoracic and thoracoabdominal native aortic and prosthetic graft infection. METHODS: This retrospective single-centre study included consecutive patients who underwent xenopericardial roll graft replacement, including branched graft reconstruction and/or tissue filling, between 2010 and 2024. A multidisciplinary treatment strategy was adopted. RESULTS: This study included 21 patients who underwent 22 procedures (median age, 67 years; interquartile range, 63.75-73.75). On a procedure basis, the indications were infectious aortic aneurysm in 4 procedures and prosthetic graft infection in 18 procedures. Replacement sites included the ascending aorta (n = 4), aortic arch (n = 11), descending aorta (n = 6), and thoracoabdominal aorta (n = 1). Tissue filling was performed in 12 procedures. The 30-day and operative mortality rates were 13.6% (3/22) and 18.2% (4/22), respectively. After excluding the three procedures with 30-day mortality, 19 procedures were included in the Kaplan-Meier analyses. Aorta-related mortality occurred in 10.5% (2/19), both due to fungal reinfection. The median follow-up was 53.6 months (IQR, 20-80.5; maximum, 132 months). The estimated survival rates at 1, 3, 5, and 7 years were 94%±6%, 76%±11%, 70%±11%, and 56%±15%, respectively. Xenopericardial roll graft-related structural complications included suture-line pseudoaneurysm (n = 2), suture-line rupture (n = 1), branch kinking (n = 1), xenopericardial roll graft body pseudoaneurysm (n = 1), and proximal anastomotic pseudoaneurysm (n = 1). No thromboembolism or graft calcification was observed. CONCLUSIONS: Xenopericardial roll graft replacement was technically feasible as part of a multidisciplinary staged strategy in selected patients with thoracic and thoracoabdominal native aortic or prosthetic graft infection. However, fungal reinfection and xenopericardial roll graft-related structural complications remain important concerns, and careful long-term surveillance is required. CLINICAL TRIAL REGISTRATION: Not applicable. This study is a retrospective observational study.