Key result
Decellularized aortic homograft fails at 19 years from severe calcific degeneration and leaflet disruption.
Why the study?
Very long-term outcomes of decellularized aortic homografts remain incompletely characterized.
Case Report (n=1)
Decellularized aortic homografts remain susceptible to very late structural degeneration, underscoring the necessity of long-term surveillance and careful operative planning for complex redo surgeries.
May signal late calcification risk after decellularized homograft; leaves open durability questions in very long-term use.
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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Kalafatakis et al. (2026) conducted a case report in bicuspid aortic valve disease and aortic root aneurysm (n=1). SynerGraft decellularized homograft was evaluated. A decellularized aortic homograft failed 19 years post-implantation due to extensive calcific degeneration and leaflet disruption, resulting in severe aortic insufficiency.
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