C. Bening

How to Deal with a Porcelain Aorta in Combined Valve Surgery

Objectives: Cardiac surgery in patients scheduled for combined single/multiple valve and CABG surgery with undetected porcelain aorta is challenging. The aim of this retrospective study was to characterize patients who were treated with “no-touch technique” and additional replacement of the ascending aorta with hypothermic circulatory arrest addressing the porcelain aorta and identify determinants for clinical outcome. Methods: From 01/2008 to 04/2015, 29 patients (75.5 ± 8.2 years, EuroSCORE II 8.3; 95% CI: 5.5–15.8) with preoperatively undetected porcelain aorta and combined single/multiple valve and CABG surgery were observed. In all patients the ascending aorta was replaced using circulatory arrest. Factors influencing a combined endpoint (hospital mortality, stroke and prolonged ventilation) were evaluated. Results: The 30-day mortality was 6.9% (n = 2), Stroke occurred in 6.9% (n = 2), prolonged ventilation was necessary in 35% (n = 10). Summarized the combined endpoint was met by 12 individual patients. The combined endpoint was influenced by history of stroke, surgery of mitral and/or tricuspid valve surgery, BSA, creatinine clearance, LVEF, however, only BSA (p = 0.0019), creatinine clearance (p = 0.035) and LVEF (p = 0.024) reached statistical significance. Mean survival was 5.26 years (CI 95%: 4.16–6.36). One year and three year survival were 85.9 ± 6.5% and 75.6 ± 9.1%, respectively. Long-term survival was significantly influenced by the combined endpoint (p = 0.011). Conclusion: Although our data indicate that undetected porcelain aorta in complex cardiac surgery can be operated with good short and long-term results, better preoperative imaging in patients at risk for porcelain aorta could influence the treatment strategy and improve clinical outcome.