Aortic valve replacement in a heavily calcified "porcelain" aorta

Although a heavily-calcified so-called "porcelain" aorta is encountered infrequently, its association presents a formidable problem in cardiac surgery. Here we describe a case of severe aortic stenosis and coronary artery disease combined with the circumferentially calcified aorta. The patient was a 63-year-old man who successfully underwent double coronary artery bypass grafting and aortic valve replacement during hypothermic perfusion through the right axillary artery with endoaortic balloon occlusion, followed by minimal endarterectomy of the calcified plate along the aortotomy, and closure of the aorta buttressed with bovine pericardium under circulatory arrest.