Abstract：
BACKGROUND: Infected aortic grafts and mycotic aneurysms represent one of the most complex challenges faced by vascular surgeons. Treatment has progressed from extra-anatomical bypass to in situ reconstruction. Additionally, bovine pericardium reconstruction (BPR) has increased, due to accessibility and reduced lower limb morbidity. There remains, however, limited evidence for its use. The aim is to pool all known data to understand outcomes following BPR of mycotic aneurysms or infected vascular grafts.
METHODS: A systematic review was conducted in November 2021 with subsequent computerized meta-analysis of the pooled results and a final search in March 2022. Three databases, Excerpta Medica dataBASE (EMBASE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), and National Institutes of Health PubMed (PubMed), were searched for the search term \"(bovine OR xenoprosthetic) AND (aneurysm)\", according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS: From 9 studies, there were 133 patients: 67% graft infections and 33% mycotic aneurysms. Fifty-seven percent of reconstructions were in the abdominal aorta and 33% were in the thoracic aorta. One hundred fifty-eight pathogens were identified, including Staphylococcus aureus (23%), Candida albicans (13%), and Escherichia coli (13%). In 12%, no microorganisms were identified. Thirty-day mortality was 19.14% (CI 10.83-28.71), late mortality was 19.08% (confidence interval [CI] 7.76-32.83), and overall mortality was 40.20% (CI 29.82-50.97). One patient died intraoperatively. There were a total of 151 in-hospital complications after 30 days postoperation. Common complications were acute renal failure (17%), pneumonia (14%), delirium (12%), respiratory insufficiency (11%) and renal insufficiency (7%). Lower limb ischemia was low, occurring in 5.66% (CI 0.54-13.82) of patients. Loss of graft patency leading to reintervention occurred in 1.20% (CI 0.00-7.71) of the grafts. Reinfection rate was 0.00% (CI 0.00-1.21).
CONCLUSIONS: This meta-analysis highlights low reinfection and high graft patency using BPR with medium-length follow-up; however, there remain limited long-term and comparative data regarding options for aortic reconstruction. As expected in this complex cohort, the complication rate and 30-day mortality remain high.
METHODS: A systematic review was conducted in November 2021 with subsequent computerized meta-analysis of the pooled results and a final search in March 2022. Three databases, Excerpta Medica dataBASE (EMBASE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), and National Institutes of Health PubMed (PubMed), were searched for the search term \"(bovine OR xenoprosthetic) AND (aneurysm)\", according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS: From 9 studies, there were 133 patients: 67% graft infections and 33% mycotic aneurysms. Fifty-seven percent of reconstructions were in the abdominal aorta and 33% were in the thoracic aorta. One hundred fifty-eight pathogens were identified, including Staphylococcus aureus (23%), Candida albicans (13%), and Escherichia coli (13%). In 12%, no microorganisms were identified. Thirty-day mortality was 19.14% (CI 10.83-28.71), late mortality was 19.08% (confidence interval [CI] 7.76-32.83), and overall mortality was 40.20% (CI 29.82-50.97). One patient died intraoperatively. There were a total of 151 in-hospital complications after 30 days postoperation. Common complications were acute renal failure (17%), pneumonia (14%), delirium (12%), respiratory insufficiency (11%) and renal insufficiency (7%). Lower limb ischemia was low, occurring in 5.66% (CI 0.54-13.82) of patients. Loss of graft patency leading to reintervention occurred in 1.20% (CI 0.00-7.71) of the grafts. Reinfection rate was 0.00% (CI 0.00-1.21).
CONCLUSIONS: This meta-analysis highlights low reinfection and high graft patency using BPR with medium-length follow-up; however, there remain limited long-term and comparative data regarding options for aortic reconstruction. As expected in this complex cohort, the complication rate and 30-day mortality remain high.
摘要：
目的：感染的主动脉移植物和霉菌性动脉瘤是血管外科医师面临的最复杂的挑战之一。治疗已从解剖外旁路发展到原位重建。此外,牛心包重建（BPR）增加，由于可及性和下肢发病率降低。仍然存在，然而,使用的证据有限。目的是汇集所有已知数据，以了解霉菌性动脉瘤或感染血管移植物的BPR后的结果。
方法：2021年11月进行了系统评价，随后对合并结果进行了计算机荟萃分析，并于2022年3月进行了最终搜索。三个数据库(EMBASE，CINAHL和PUBMED)搜索搜索词“(牛或异种)和(动脉瘤)”，根据PRISMA指南。
结果：从九项研究中，有133例患者：67％的移植物感染;33％的霉菌性动脉瘤。57％的重建在腹主动脉中，33％在胸主动脉中。确定了158种病原体，包括金黄色葡萄球菌（23%），白色念珠菌（13%）和大肠杆菌（13%）。12%，没有发现微生物。30天死亡率为19.14%（CI10.83-28.71），晚期死亡率为19.08%(CI7.76~32.83),总死亡率为40.20%(CI29.82~50.97).一名患者术中死亡。术后30天，共有151例住院并发症。常见的并发症是急性肾功能衰竭（17％），肺炎（14%），谵妄（12%），呼吸功能不全（11％）和肾功能不全（7％）。下肢缺血低，发生在5.66%(CI0.54-13.82)的患者中。1.20％（CI0.00-7.71）的移植物通畅性丧失导致再次干预。再感染率为0.00%(CI0.00～1.21)。
结论：这项荟萃分析强调了使用BPR和中等时间随访的低再感染和高移植物通畅性，然而,关于主动脉重建方案的长期和比较数据仍然有限.正如在这个复杂的队列中所预期的那样，并发症发生率和30日死亡率仍然很高.
方法：2021年11月进行了系统评价，随后对合并结果进行了计算机荟萃分析，并于2022年3月进行了最终搜索。三个数据库(EMBASE，CINAHL和PUBMED)搜索搜索词“(牛或异种)和(动脉瘤)”，根据PRISMA指南。
结果：从九项研究中，有133例患者：67％的移植物感染;33％的霉菌性动脉瘤。57％的重建在腹主动脉中，33％在胸主动脉中。确定了158种病原体，包括金黄色葡萄球菌（23%），白色念珠菌（13%）和大肠杆菌（13%）。12%，没有发现微生物。30天死亡率为19.14%（CI10.83-28.71），晚期死亡率为19.08%(CI7.76~32.83),总死亡率为40.20%(CI29.82~50.97).一名患者术中死亡。术后30天，共有151例住院并发症。常见的并发症是急性肾功能衰竭（17％），肺炎（14%），谵妄（12%），呼吸功能不全（11％）和肾功能不全（7％）。下肢缺血低，发生在5.66%(CI0.54-13.82)的患者中。1.20％（CI0.00-7.71）的移植物通畅性丧失导致再次干预。再感染率为0.00%(CI0.00～1.21)。
结论：这项荟萃分析强调了使用BPR和中等时间随访的低再感染和高移植物通畅性，然而,关于主动脉重建方案的长期和比较数据仍然有限.正如在这个复杂的队列中所预期的那样，并发症发生率和30日死亡率仍然很高.
