How to tackle an unexpected pocelain aorta in the setting of planned aortic valve replacement combined with coronary surgery?

Abstract

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. Our patient had uneventful postoperative courses without any neurological disorders, or worsening of his moderate kidney failure. He was discharged within postoperative day 15. After 12 months of follow-up, he was asymptomatic and his transprosthetic mean pressure gradient was 23 mmHg.