Late Failure of Decellularized Cryopreserved Aortic Homograft.

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.