Sutureless aortic valve implantation in patient with porcelain aorta via unclamped aorta and deep hypothermic circulatory arrest

Off-pump Coronary Surgery Combined With Aortic Valve Replacement Under Hypothermic Circulatory Arrest Within an Unexpected Porcelain Aorta

Unexpected porcelain aorta is a real challenge to safely completing aortic valve replacement combined with coronary artery surgery. This condition often leads to an aborted sternotomy in the hope of performing transcatheter procedures, the feasibility of which may be hampered by anatomical considerations. We report the case of a 71-year old man with history of hypertension, type 2 diabetes mellitus and chronic kidney disease, which was referred for severe aortic valve stenosis and severe coronary artery disease. He benefited from an anaortic off-pump coronary surgery and clampless aortic valve replacement under hypothermic circulatory arrest to overcome an unexpected porcelain aorta.

Porcelain aorta does not mean inoperability but needs special strategies

Porcelain aorta is not an absolute contraindication for aortic valve and/or coronary bypass grafting but it requires a special strategy and individualized approach to minimize the risk of embolic complications and technical problems during opening and/or closing the aortotomy.

Aortic valve replacement in porcelain aorta-a novel technique for endoaortic occlusion

Aortic valve surgery invariably becomes a high-risk, challenging procedure when there is extensive calcification of the ascending aorta which precludes safe cross-clamping. Very few case reports of performing aortic valve surgery in this condition with a non-cross-clamping technique of using endoaortic occlusion have been reported. We describe and recommend a non-cross-clamping technique of using a semi-compliant polyurethane balloon catheter (CODA balloon, Cook Incorporated, Bloomington, IN) and report its successful outcome in a patient, with porcelain aorta, who underwent aortic valve replacement.