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Porcelain Aorta and AVR Strategy — EECC MCQ

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ModerateValvular Heart DiseasePorcelain Aorta and AVR StrategyEECC

A 72-year-old man with severe aortic stenosis and a porcelain aorta (heavily calcified ascending aorta) is considered for valve intervention. What does the porcelain aorta imply for treatment selection?

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Correct answer: C — SAVR via sternotomy with aortic cross-clamping carries very high risk; TAVI via transfemoral or alternative access is the preferred approach

Porcelain aorta (severe circumferential calcification of the ascending aorta) significantly increases the risk of conventional SAVR due to: (1) difficulty and danger of aortic cross-clamping (risk of aortic wall injury, massive embolisation of atheromatous/calcific debris causing stroke), (2) difficulty of aortotomy, and (3) inability to establish cardiopulmonary bypass via standard ascending aortic cannulation. TAVI, particularly via the transfemoral approach (which avoids manipulation of the ascending aorta entirely), is the preferred strategy. Alternative TAVI access routes (transapical, trans-subclavian, transcarotid, transcaval) may also avoid the ascending aorta. The 2025 ESC VHD Guidelines recognise porcelain aorta as a factor favouring TAVI.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease