Aortic homografts are composed of aortic roots and variable lengths of the arch and ascending aorta, harvested from donor hearts. They are primarily used in extensive aortic root endocarditis due to ...its resistance to reinfection. They are, however, prone to structural failure. Redo aortic root surgery is challenging, especially in the setting of aneurysms or pseudoaneurysms (PSAN) lying immediately posterior to the sternum or adhering to it. We present a 43-year-old female with two aortic homograft pseudoaneurysms following her fourth aortic valve and ascending aortic procedure. The first PSAN was described as immediately cranial to proximal homograft anastomosis, measuring 21x8 millimeters. It harbored potential for intraoperative rupture because of its proximity to the posterior sternal table. The second one was 36x20 millimeters, adjacent to the distal homograft anastomosis. The surgical plan entailed institution of peripheral hypothermic cardiopulmonary bypass due to an almost inevitable risk of bleeding from the retrosternal pseudoaneurysm. While the actual sternotomy was uneventful, the PSAN ruptured after sternal retraction. The ensuing massive bleeding was expected and was success- fully managed during hypothermic circulatory arrest. The patient had an unremarkable postoperative course and was discharged home.
