Systematic review and meta-analysis of the efficacy and safety of xenopericardium for vascular reconstruction in arterial prosthetic graft infection

BACKGROUND: Despite substantial progress in graft materials and surgical techniques, arterial graft infections continue to pose significant clinical challenges. The optimal graft material remains debated, with prosthetic grafts being associated with elevated reinfection and mortality rates. Given the growing interest in xenogeneic pericardium, this study aimed to systematically evaluate its efficacy and safety in the management of prosthetic graft infections. METHODS: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. PubMed/MEDLINE and the Cochrane Library were searched up to July 7, 2024. Studies reporting on the use of xenogeneic pericardium for vascular reconstruction in prosthetic graft infections were included. Data on demographics, clinical outcomes, reinfection rates, mortality, graft patency, and complications were extracted. RESULTS: Eight studies involving 222 patients (182 males; mean age 67.7 ± 9.1 years) were included. Microbial analysis of 190 culture-positive cases identified Staphylococcusspecies (20%), fungi (14%), Enterococcus faecalis (12%), Streptococcusspp. (11%), and Escherichia coli (10%) as the most common pathogens. Mean follow-up duration ranged from 9 to 26 months. Cumulative mortality rates were 13% (95% CI: 8%-18%) at 30 days, 32% (95% CI: 25%-39%) at 1 year, and 35% (95% CI: 29%-42%) at 2 years. The reinfection rate was 5% (95% CI: 2%-9%), while graft occlusion and anastomotic pseudoaneurysm rates were both 3% (95% CIs: 0%-6% and 1%-7%, respectively). CONCLUSION: Xenogeneic pericardium is a viable alternative for vascular reconstruction in graft infection scenarios, associated with acceptable reinfection and complication rates. It offers a promising option, particularly when autologous or allograft materials are unavailable.