Strategy for Porcelain Ascending Aorta in Cardiac Surgery.

Aging of the population and the increase in patients on dialysis have led to an increasing frequency of “porcelain aorta” (subtotal circumferential calcification of the ascending aorta) in patients undergoing cardiac surgery.1) Porcelain aorta is reported to be associated with higher morbidity and mortality, especially related to stroke.2,3) Cardiac surgery is more complex in patients with porcelain aorta and their management can be difficult because of the increased risk of perioperative atheroembolism and aortic dissection. Selection of the operative procedure can be problematic, as well as deciding the appropriateness of aortic cross-clamping, identifying the arterial cannulation site, performing proximal anastomosis for coronary artery bypass grafting (CABG), and devising an aortotomy procedure for aortic valve replacement (AVR). Recently, transcatheter aortic valve replacement (TAVR) has become feasible in patients with porcelain aorta for whom conventional AVR is a high-risk procedure.4) This review summarizes the published data on strategies for coping with porcelain aorta during cardiac surgery. Strategy for Porcelain Ascending Aorta in Cardiac Surgery