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The Porcelain Aorta

In some patients atherosclerosis of the ascending aorta is so extensive that the entire wall is heavily calcified and clamping is impossible (Figure 12-33). Some of these aortas have a soft spot where cannulation may be possible, but others do not and axillary cannulation may be required. Whereas coronary work can be done without a pump or on a fibrillating heart and other valve work can be done without clamping the aorta, the aortic valve normally cannot be replaced without opening the aorta. The operative strategy has been to use systemic cooling to deep hypothermia and then use circulatory arrest. In rare instances, the aorta can be opened safely at the root, the valve quickly replaced, and the aortotomy closed all under one period of circulatory arrest. In general, the time required to do this is excessive or the root itself is too calcified to allow a safe aortotomy, so graft replacement of the ascending aorta is typically required. The graft is then clamped, …