Ascending Aorta to Femoral Bypass with Cryopreserved Vascular Homografts

Abstract

Homograft vascular replacement is almost as old as vascular surgery itself. Gross and Dubost are credited as the first authors who clinically attempted vascular reconstruction using biological tissue of human origin. The advent of synthetic vascular prostheses together with the complexity of logistics in procuring, preserving, and storing vascular homografts made the routine use of vascular homografts impractical. Cryopreservation techniques have strongly influenced the use of biological tissue. The tireless work of a few authors has enabled us to better understand the behavior of homograft tissues in cardiovascular surgery. Homograft replacement of the aortic and pulmonary valves is now a recognized way to treat a number of conditions of the aortic root and the right ventricular outflow tract. Renewed interest in the use of cryopreserved homografts in cardiac surgery has led us to expand our own indications for their use. As our Cryopreservation Unit is fully operative, we also have vascular homografts available for implantation. Here we describe the extended use of vascular homografts in extraanatomic aortic bifurcation bypass in a patient with previous multiple vascular operations. To use the ascending aorta as the inflow source in cardiovascular reconstruction has been previously described; however, it has not been popular among surgeons. Robicsek termed this type of bypass graft “very long” aortic grafts, and we recently had the chance to use fully biological tissue of human origin for this type of reconstruction.