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Peer-reviewedCC BY 4.0JACC Case Reports

Late Failure of Decellularized Cryopreserved Aortic Homograft

  • Fotios Kalafatakis1
  • Uzma Rahman2
  • Sriharsha Talapaneni3
  • Hazar Kadirogullari4
  • Ahmet Kilic2
4 affiliations
  1. 1School of Medicine, University of Patras School of Medicine, Patras, Greece
  2. 2Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
  3. 3Georgetown University School of Medicine, Washington DC, USA
  4. 4School of Medicine, Koc University School of Medicine, Istanbul, Turkey
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Abstract

Background: Decellularized aortic homografts were developed to reduce immunogenicity, but very long-term outcomes remain incompletely characterized.

Case Summary: A 54-year-old woman underwent aortic root replacement with a 22-mm SynerGraft decellularized homograft for bicuspid aortic valve disease and aortic root aneurysm. Nineteen years later, she presented with acute heart failure caused by severe aortic insufficiency. Preoperative imaging demonstrated a heavily calcified retrosternal aortic root, guiding a bilateral thoracosternotomy for redo root replacement. Operative and histopathologic findings showed extensive calcific degeneration with left coronary leaflet disruption. Recovery was uneventful.

Discussion: This case illustrates a possible very late failure pattern of a decellularized homograft and underscores the importance of meticulous preoperative imaging and individualized operative planning.

Take-Home Messages: Decellularized aortic homografts may remain susceptible to very late structural degeneration. Careful imaging and tailored surgical planning are essential for complex redo aortic root surgery.

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Cite

BibTeXRIS
BibTeX
@article{kalafatakis2026late,
  title = {{Late Failure of Decellularized Cryopreserved Aortic Homograft}},
  author = {Fotios Kalafatakis and Uzma Rahman and Sriharsha Talapaneni and Hazar Kadirogullari and Ahmet Kilic},
  journal = {JACC Case Reports},
  year = {2026},
  month = sep,
  doi = {10.1016/j.jaccas.2026.109897},
  url = {https://doi.org/10.1016/j.jaccas.2026.109897},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Late Failure of Decellularized Cryopreserved Aortic Homograft
AU  - Fotios Kalafatakis
AU  - Uzma Rahman
AU  - Sriharsha Talapaneni
AU  - Hazar Kadirogullari
AU  - Ahmet Kilic
PY  - 2026
DA  - 2026/09/02
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.109897
UR  - https://doi.org/10.1016/j.jaccas.2026.109897
AB  - Background: Decellularized aortic homografts were developed to reduce immunogenicity, but very long-term outcomes remain incompletely characterized.  Case Summary: A 54-year-old woman underwent aortic root replacement with a 22-mm SynerGraft decellularized homograft for bicuspid aortic valve disease and aortic root aneurysm. Nineteen years later, she presented with acute heart failure caused by severe aortic insufficiency. Preoperative imaging demonstrated a heavily calcified retrosternal aortic root, guiding a bilateral thoracosternotomy for redo root replacement. Operative and histopathologic findings showed extensive calcific degeneration with left coronary leaflet disruption. Recovery was uneventful.  Discussion: This case illustrates a possible very late failure pattern of a decellularized homograft and underscores the importance of meticulous preoperative imaging and individualized operative planning.  Take-Home Messages: Decellularized aortic homografts may remain susceptible to very late structural degeneration. Careful imaging and tailored surgical planning are essential for complex redo aortic root surgery.
SN  - 2666-0849
ER  -