title: Total arch replacement with endarterectomy of the ascending aorta in a patient with aortic arch aneurysm and porcelain aorta.
abstract: We describe total arch replacement for aortic arch aneurysm with a severely calcified ("porcelain") aorta. Cardiovascular surgery is challenging under such conditions because the calcified plate interferes with clamping, incising, and suturing of the aorta. We performed this surgery under hypothermic circulatory arrest with antegrade cerebral perfusion. Calcification manifested particularly in the ascending aorta and prevented the use of a needle. We exfoliated the calcified intimal plate using an elevator designed for hand surgery, and then covered both the inner and outer sides of the endarterectomized aorta with a strip of bovine pericardium to reinforce the anastomotic region and cover the rough surface. No complications developed during or after surgery.
authors.affiliation: Department of Cardiovascular Surgery, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Miyaki
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kaneko
authors.forename: Ryo
authors.initials: R
authors.lastname: Suzuki
authors.forename: Mikihiko
authors.initials: M
authors.lastname: Kudo
authors.forename: Ryohei
authors.initials: R
authors.lastname: Yozu
mesh_terms: D000368:Aged; D000818:Animals; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D002417:Cattle; D002560:Cerebrovascular Circulation; D050792:Circulatory Arrest, Deep Hypothermia Induced; D004691:Endarterectomy; D006801:Humans; D008297:Male; D010477:Perfusion; D010496:Pericardium / Q000637:transplantation; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome