Surgical resolution of mechanical prosthetic dysfunction in a patient with a porcelain aorta

Abstract

We present a clinical case with a satisfactory surgical outcome of a patient in the seventh decade of life with a diagnosis of dysfunction of a mechanical valve prosthesis in the aortic position and with a calcified aorta (porcelain aorta) from the root to the bifurcation of the iliac arteries. The decision for surgical replacement of the aortic valve was based on the presence of thrombosis and pannus, which, in addition, were the cause of severe aortic stenosis and secondary mitral insufficiency, also severe.
This scenario is not accounted for in cardiovascular surgical risk scales, such as the EuroSCORE, the Society of Thoracic Surgeons (STS) risk scale, or the Parsonnet scale, among others. This adds a further risk for this procedure, as this fully calcified aortic morphology increases the predisposition for aortic dissection or rupture. For this reason, the repair is difficult because there is no adequate plane for the coaptation of the surgical suture. In this patient, age, the presence of comorbidities such as chronic renal failure, severe pulmonary hypertension, the need for reoperation, and tissues in poor condition are added as risk factors, despite which the postoperative result was satisfactory.