What is aortic calcification?

From the Guidelines

Aortic calcification is a condition characterized by the deposition of calcium in the aortic wall, often associated with atherosclerosis and representing a central component of atherogenesis.

Key Characteristics

• Vascular calcification occurs in the media of the aorta, signaling long-standing inflammation 1
• The amount of calcification directly associates with the extent of atherosclerosis, and the presence of aortic calcium predicts the presence of coronary heart disease 1
• Severe atherosclerosis of the aorta can cause severe and diffuse calcification, leading to an "eggshell" appearance on chest x-ray or CT, also known as "porcelain aorta" 1

Clinical Implications

• Aortic calcification can interfere with cannulation of the aorta, cross-clamping, and placement of coronary bypass grafts, increasing the risk of stroke and distal embolism 1
• Direct manipulation of the aorta may result in unrepairable aortic injury and/or distal embolization 1
• Surgeons use techniques such as internal aortic balloon occlusion, "no-touch" technique, and alternate locations for cannulation or coronary bypass graft anastomoses to reduce adverse neurologic events 1

Risk Factors

• Risk factors for the development of aortic atheroma include age, sex, heredity, hypertension, diabetes mellitus, hyperlipidemia, sedentary lifestyle, smoking, and endothelial dysfunction 1
• Calcified plaques are more stable and less likely to result in embolic syndromes, whereas plaques with a larger lipid core, a predominance of macrophages, a thin fibrous cap, and a lack of calcification are more "vulnerable" to disruption or rupture 1

From the Research

Definition of Aortic Calcification

• Aortic calcification, also known as "porcelain aorta," refers to the extensive calcification of the ascending aorta or aortic arch 2, 3, 4.
• This condition can complicate cardiac surgery and increase perioperative risk, particularly for embolic stroke 2, 3, 4.

Classification of Aortic Calcification

• Aortic calcification can be classified into different types based on its location and impact on therapeutic approach 3.
• Type I implies localization of circumferential calcification in the ascending aorta, with subtypes IA and IB representing calcified aorta with and without possibility of clamping, respectively 3.
• Type II addresses the calcification of the descending aorta, including or not the aortic arch 3.

Clinical Implications of Aortic Calcification

• Aortic calcification can lead to severe aortic stenosis, which restricts the aortic valve opening during systole due to calcification and fibrosis of the aortic valve 5.
• Symptoms of severe aortic stenosis include exercise intolerance, exertional dyspnea, and syncope, with a 1-year mortality rate of up to 50% without aortic valve replacement 5.
• Management of aortic calcification and aortic stenosis involves patient education, clinical and echocardiographic surveillance, and treatment of hypertension, hyperlipidemia, and cigarette smoking 5.

Surgical Considerations for Aortic Calcification

• Surgical procedures for aortic calcification, such as aortic valve replacement and transcatheter aortic valve implantation, require careful preoperative evaluation and planning by a multidisciplinary team 2, 4, 6.
• Techniques such as endoaortic balloon occlusion and hypothermic circulatory arrest with selective cerebral perfusion can be used to facilitate safe conduct of surgery in patients with aortic calcification 2, 6.