Transcatheter Aortic Valve Replacement Explant in the Setting of a Porcelain Aorta

Porcelain aorta describes circumferential calcification in the ascending aorta that may extend through the aortic arch. This is commonly observed in patients with a history of mediastinal radiation, end-stage renal disease, or chronic vascular inflammation. Mediastinal radiation has been shown to cause intimal and medial calcification of the aorta, as well as diastolic myocardial dysfunction, valvular disease, and coronary artery disease. In recent years, patients with aortic stenosis and concomitant porcelain aorta have been increasingly managed with transcatheter aortic valve replacements rather than surgical replacement to reduce periprocedural risks. We describe the surgical management of a patient with severe mitral valve stenosis, porcelain aorta, and patient prosthesis mismatch from a previously deployed transcatheter aortic valve replacement using right axillary arterial canulation and hypothermic circulatory arrest. To our knowledge, this is the first published case where a porcelain aorta was replaced surgically after failed transcatheter management of severe aortic stenosis.