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Updated: Sep 26, 2026
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
[Surgery of aortic valve stenosis with porcelain aorta under hypothermic circulatory arrest]
Arpád Péterffy1, Endre Jagamos, Lajos Szentgyörgyi
1Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Altalános Orvostudomány Kar, Szívsebészeti Klinika.
Insights
This case report details a successful surgical intervention for severe aortic valve stenosis and porcelain aorta. The patient recovered well after aortic valve and ascending aorta replacement, returning to work symptom-free.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Valve Disease
Background:
- Severe calcific aortic valve stenosis poses significant surgical challenges, especially when associated with porcelain aorta.
- Previous attempts at aortic valve replacement were deemed too high-risk due to extensive aortic calcification.
Observation:
- A 52-year-old male presented with worsening symptoms of severe calcific aortic valve stenosis and porcelain aorta.
- The patient had a history of a prior exploratory sternotomy where valve replacement was not performed due to high surgical risk.
Findings:
- The patient underwent successful aortic valve replacement with a mechanical prosthesis and replacement of the calcified ascending aorta with a vascular graft.
- The complex procedure was performed under deep hypothermia and total circulatory arrest, utilizing cardiopulmonary bypass.
- The calcified ascending aorta was excised without cross-clamping, and the graft was anastomosed to the aortic arch.
Implications:
- This case demonstrates the feasibility and successful outcome of complex aortic valve and ascending aorta replacement in a high-risk patient with porcelain aorta.
- The surgical technique employed allowed for safe management of extensive aortic calcification, leading to a positive patient recovery and return to normal activities.
Abstract:
This is a case report of a 52 year-old male patient with severe calcific aortic valve stenosis, associated with extended circular calcification of the ascending aorta and the aortic arch. Six months ago the patient underwent an explorative sternotomy in another institute, but the aortic valve replacement was not performed regarding the great risk of the porcelain aorta. The patient's complaints became more severe, so the authors recommended the excision both of the stenotic aortic valve and the calcified ascending aorta and replacement with a mechanical valve and vascular prosthesis. The operation was performed in deep hypothermia and total circulatory arrest with help of cardiopulmonary bypass. The calcified ascending aorta was excised without crossclamping. The vascular graft used for replacement of the ascending aorta was anastomosed to the proximal part of the aortic arch, then it was clamped and the extracorporal circulation was started again with rewarming of the patient. The aortic valve was replaced with a 21 mm St. Jude HP mechanical valve prosthesis in the usual manner. At last, the graft was anastomosed supracoronary to the proximal stump of the ascending aorta. Extracorporal circulation was discontinued without any difficulties. Apart from a few days of somnolence, the patient's recovery was uneventful, he was discharged from hospital on the 12th postoperative day. Three months after the surgery he had no complaints and returned to work without any problems.
