Endarterectomy for calcified porcelain aorta associated with aortic valve stenosis

Svensson, Lars G.; Sun, Jian-Ping; Cruz, Hernán; Shahian, David M.

doi:10.1016/0003-4975(95)00984-1

Cited by 45 publications

(32 citation statements)

References 7 publications

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“…They described replacing traditional aortic cross-clamping with femoral artery cannulation, profound hypothermia, and circulatory arrest with replacement of the ascending aorta to minimize the risk of aortic embolization or dissection. Svensson et al 13 defined PA as calcification of the ascending aorta and aortic arch involving predominantly the aortic media. Leyh et al 14 analyzed 1861 patients undergoing coronary artery bypass grafting (CABG) and found 23 patients (1.2%) with PA defined as circumferential severe calcification of the entire ascending aorta and proximal aortic arch.…”

Section: Definition and Diagnosismentioning

confidence: 99%

“…8,90 With this technique, the ascending aorta can be managed with several strategies: aortotomy low on the ascending aorta if any noncalcified area is present 8 or replacement of the ascending aorta 8,89 and ascending aortic endarterectomy. 8,13 Although most of the procedures can be performed with <20 minutes of circulatory arrest, there may be some reluctance to perform deep hypothermic circulatory arrest in the setting of advanced age and significant comorbidities. 91 Another option to avoid aortic cross-clamping and manipulation in patients with severe AS is the apico-aortic conduit technique.…”

Section: Pa and Cardiac Surgerymentioning

confidence: 99%

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Porcelain Aorta

et al. 2015

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Section: Definition and Diagnosismentioning

confidence: 99%

Section: Pa and Cardiac Surgerymentioning

confidence: 99%

Porcelain Aorta

et al. 2015

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“…However, potential aneurysmal degeneration of the endoarterectomized aortic wall needs to be monitored. 7) An ultrasonic surgical aspirator is useful for decalcifying and softening an anastomotic site during surgery in a calcified valve. 14) Cosgrove 1) and other researchers 3,6) report that inflating the occluding balloon at the distal ascending aorta after circulatory arrest, reinstituting circulation, and replacing the aortic valve during rewarming are useful in shortening the circulatory arrest time.…”

Section: Discussionmentioning

confidence: 99%

A Stepwise Aortic Clamp Procedure to Treat Porcelain Aorta Associated with Aortic Valve Stenosis and Hemodialysis

Isoda

Osako

Kimura

et al. 2014

ATCS

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IntroductionAortic valve surgery of a patient with a porcelain aorta can be problematic because of the increased risk of perioperative atheroembolism. [1][2][3] The current strategies for aortic valve surgery of patients with a porcelain aorta are deep hypothermic circulatory arrest, 4) graft replacement, 5) balloon occlusion, 1,3,6) endoarterectomy, 7) apico-aortic valved conduit, 8) and transcatheter aortic valve implantation. 9) Since each modality has its unique problems and limitations, the porcelain aorta is a challenge for the cardiac surgeon. The case of the replacement of an aortic valve in a patient with a porcelain aorta is presented here. He was successfully treated with a stepwise aortic clamp procedure that combined circulatory arrest, endoarterectomy, balloon occlusion, and sequential normal cardiopulmonary bypass (CPB) perfusion under a cross-clamp. Case ReportA 62-year-old man had undergone mitral valve commissurotomy 30 years back. 9 years ago, the valve had been replaced by a 27-mm mechanical valve (St. Jude Medical, Inc., St. Paul, Minnesota, USA). He was admitted to our hospital because of orthopnea. He had been undergoing hemodialysis for 8 years, diagnosed as having A Stepwise Aortic Clamp Procedure to Treat Porcelain Aorta Associated with Aortic Valve Stenosis and HemodialysisSusumu Isoda, MD, Motohiko Osako, MD, Tamizo Kimura, MD, Kenji Nishimura, MD, Nozomu Yamanaka, PhD, Shingo Nakamura, PhD, and Tadaaki Maehara, MD A 62-year-old man was referred for an aortic-valve surgery because of severe aortic stenosis. Thirty years ago, he had undergone a mitral valve commissurotomy and after 9 years, the valve had been replaced by a mechanical valve. He had been undergoing hemodialysis for the past 8 years. A computed tomographic (CT) scan of the chest and abdomen showed a dense circumferential calcification in the wall of the entire thoracic and abdominal aorta, pulmonary artery, and left and right atrium. A conventional aortic-valve replacement was performed. To avoid an embolic event, a "stepwise aortic clamp" procedure was attempted and involved the following: (1) brief circulatory arrest and aortotomy during moderate hypothermia; (2) balloon occlusion at the ascending aorta during low-flow cardiopulmonary bypass (CPB); (3) endoarterectomy by using an ultrasonic surgical aspirator to enable aortic cross-clamping; and (4) a cross-clamp reinforced with felt and full-flow CPB. The patient recovered without any thromboembolic events. Using this procedure to treat a porcelain aorta seemed to reduce the time limit and reduced the risk of brain injury during cardiac surgery.

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“…Although the no-touch technique to the calcified aorta effectively reduces the surgical risk of atheroembolic events, prolonged HCA time is a risk for stroke 19) . As a different strategy to facilitate AVR, endarterectomy during HCA has been reported to avoid embolic events 13,20) . No patients with postoperative stroke www.intechopen.com suggested a good early result, but there were no follow-up data relating to the long-term risks of aortic dissection or dilatation.…”

Section: Discussionmentioning

confidence: 99%