[Aortic valve replacement in a patient with severely calcified small aorta valve and ascending aorta]

A 74-year-old male with severely calcified aortic valve and ascending aorta underwent aortic valve replacement. Cannulation as well as cross clamping of the ascending aorta was avoided because there might be a definite risk of cerebral embolism caused by liberated atheromatous debris on manipulation of the ascending aorta. The extracorporeal circulation was established by femoral arterial and right atrial cannulation, and the aorta was cross-clamped at the soft distal arch. Selective cerebral perfusion catheters were inserted via a longitudinal aortotomy made at a soft anterior portion of the ascending aorta, through which the valve replacement procedure was carried out. The aortic valve annulus was narrow (barely 21 mm in diameter), so that the interrupted mattress suturing technique with the pledgets placed below the annulus in the left ventricular outflow tract was adopted. By this supraannular suturing method a bioprosthesis was easily secured above the annulus as the thickened annulus was compressed between the sutures and the device.