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

Porcelain aorta, though rare, is often considered a contraindication for open surgery due to the risk of associated neurological complications due to calcium embolization. We present the case of a 70-year-old female with a prior 19mm bioprosthetic aortic valve replacement who, during routine follow-up, was found to have significant aortic valve stenosis, severely reduced leaflet mobility and a mean gradient of 40mmHg. Pre-operative computed tomography angiography revealed a calcified 'porcelain aorta'. Transcatheter aortic valve-in-valve replacement was not possible due to the small 19mm valve and small aortic sinuses, leading to referral for open aortic surgery.