Open aortic root in a porcelain aorta when TAVR is not feasible

Area of Science:

• Cardiology
• Cardiac Surgery
• Vascular Medicine

Background:

• Porcelain aorta, characterized by extensive aortic calcification, poses significant risks for cardiovascular procedures.
• Neurological complications from calcium embolization are a primary concern, often contraindicating open surgical interventions.

Purpose of the Study:

• To present a complex case of severe aortic stenosis in a patient with a porcelain aorta.
• To discuss the management challenges and decision-making process when transcatheter aortic valve-in-valve replacement is not feasible.

Main Methods:

• A 70-year-old female patient with a history of aortic valve replacement was diagnosed with severe aortic stenosis.
• Pre-operative computed tomography angiography confirmed a porcelain aorta.
• Transcatheter aortic valve-in-valve replacement was deemed impossible due to anatomical constraints.

Main Results:

• The patient presented with severe aortic valve stenosis and reduced leaflet mobility.
• Computed tomography angiography confirmed extensive aortic calcification, indicative of a porcelain aorta.
• The patient's anatomy precluded transcatheter aortic valve-in-valve replacement, necessitating consideration for open surgery.

Conclusions:

• Managing severe aortic stenosis in the presence of a porcelain aorta requires careful risk assessment.
• When transcatheter options are contraindicated, open aortic surgery remains a viable, albeit high-risk, alternative.
• This case underscores the importance of individualized treatment strategies for complex cardiovascular conditions.