Key result
Stepwise aortic clamping enables successful AVR without thromboembolic events in a porcelain aorta.
Why the study?
Porcelain aorta associated with severe aortic stenosis and hemodialysis poses a high risk of embolic events during conventional aortic valve replacement, requiring safer surgical techniques.
Does a stepwise aortic clamp procedure prevent thromboembolic events in a patient with severe aortic stenosis and a porcelain aorta undergoing aortic valve replacement?
Case Report (n=1)
Does a stepwise aortic clamp procedure prevent thromboembolic events in a patient with severe aortic stenosis and a porcelain aorta undergoing aortic valve replacement?
A stepwise aortic clamp procedure combining circulatory arrest, balloon occlusion, and endoarterectomy may be a safe approach to avoid thromboembolic events during aortic valve replacement in patients with a porcelain aorta.
Alerts to porcelain aorta in long-term hemodialysis patients undergoing valve surgery; leaves open optimal risk stratification and techniques.
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 Thirty years ago, he had undergone a mitral valve commissurotomy and after 9 years, the valve had been replaced by a mechanical valve.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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Isoda et al. (2013) conducted a case report in Severe aortic stenosis and porcelain aorta (n=1). Stepwise aortic clamp procedure was evaluated on Successful aortic valve replacement without thromboembolic events. A stepwise aortic clamp procedure successfully enabled aortic valve replacement without thromboembolic events in a patient with a porcelain aorta.
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