Ann R Coll Surg Engl. 2026 Jan 12. doi: 10.1308/rcsann.2025.0116. Online ahead of print.

ABSTRACT

INTRODUCTION: Infected aortic fields are among the most complex surgical challenges, often requiring urgent intervention and associated with a high risk of morbidity and mortality. Bovine pericardium offers a customisable, off-the-shelf option for in situ reconstruction using biological material. We evaluate long-term outcomes following emergency bovine pericardium neo-aorta reconstruction in infected aortic fields.

METHODS: Prospectively collected data for all patients treated with bovine pericardium neo-aorta reconstructions from 2018 to date were analysed. The surgical approach included resection of the infected aortic segment, explantation of previous grafts and/or stents, and reconstruction of the neo-aorta using a bovine pericardium sheet. Data collected included patient demographics, comorbidities, clinical presentation, previous interventions, blood tests, complications, length of antibiotic treatment and long-term survival. All neo-aortas were enrolled in an annual ultrasound surveillance programme to monitor for aneurysmal degeneration.

RESULTS: Fifteen aortic reconstructions were performed. The most common indication was aorto-enteric fistulas (n = 7), followed by infected aortic grafts (n = 4), mycotic aneurysms (n = 3) and one contaminated field due to emergency colectomy. Median follow-up was 34 months (range 9-84). Thirty-day mortality was 7%, with another 7% at 10 weeks. Antibiotic-free survival rate was 86%. One patient (7%) required long-term antibiotics post-partial endovascular aneurysm repair explant. Complications included one graft occlusion with limb loss and one case of end-stage renal failure. No aneurysmal degeneration was identified during follow-up.

CONCLUSION: Bovine pericardial neo-aorta reconstructions have shown excellent long-term resistance to infections and very good durability. Our data add to growing evidence supporting off-the-shelf use of bovine pericardium in emergency aortic reconstruction. Larger numbers through multicentre studies or special registries would help support more regular use.

PMID:41524123 | DOI:10.1308/rcsann.2025.0116