Aortotomy and Endarterectomy of the Ascending Aorta for Aortic Valve Replacement in a Patient with Porcelain Aorta

Patients with a calcified “porcelain” aorta may also have aortic valve stenosis, necessitating aortic valve replacement to prevent cerebral complications. However, a porcelain aorta can be difficult to open, and ascending aorta repair sutures are almost impossible to insert in a calcified plate. We devised a method of aortotomy using a small oscillating saw, which allowed us to incise the aortic wall cleanly without destruction or the formation of debris. After partial endarterectomy of the calcified plate with aortotomy, closure of the aorta was buttressed with bovine pericardium. During the endarterectomy, we used an elevator designed for hand surgery to exfoliate the calcified intimal plate.