Total aortic arch replacement by a cryopreserved aortic homograft

Abstract

The case is presented of a 60-year-old man with previous surgery on the transverse aorta and a pseudoaneurysm of the aortic arch and hemoptysis. The patient was operated upon with cardiopulmonary bypass and cerebral perfusion. The aortic arch was resected preserving a cuff of the aorta containing the three supra-aortic trunks. A bronchial fistula was closed with a pediculated flap of the native arch. A long segment of cryopreserved human aorta (ascending, arch and upper descending thoracic aorta) was inserted in the orthotopic position. The aortic cuff with the supra-aortic vessels was re-inserted onto the allograft. The patient is asymptomatic 2 months after the operation. Aortic homografts are a good alternative in cases with suspected infection or contamination, like this one. Other conditions, such as infected aneurysms, infected grafts, aorto-esophageal fistula and aorto-gastrointestinal fistula, are potentially good candidates for homografting. We believe that this case is the first report of a complete substitution of the aortic arch with a human cryopreserved homograft.