Management of Aortic Calcification

Clinical Significance of Aortic Calcification

Aortic calcification represents a central component of atherogenesis, typically signaling long-standing inflammation, and directly associates with the extent of atherosclerosis 1
The presence of aortic calcium predicts the presence of coronary heart disease and is associated with an increased risk of death and cardiovascular disease 1
Severe calcification (termed "porcelain aorta") appears as an eggshell appearance on chest x-ray or CT and significantly increases the risk of stroke and distal embolism during cardiac procedures 1, 2

Consider additional testing to quantify comorbid states and develop a risk profile, including pulmonary function tests, cardiac catheterization, carotid artery screening, and echocardiography 1

Implement aggressive cardiovascular risk factor modification including blood pressure control, lipid management, diabetes control, and smoking cessation 1
Document the extent and location of calcification for surgical planning if cardiac surgery is anticipated 1, 3
If cardiac surgery is required, special surgical techniques may be necessary to reduce adverse neurologic events, including internal aortic balloon occlusion 1, 2, "no-touch" technique to avoid the ascending aorta 2, alternative locations for cannulation or coronary bypass graft anastomoses 2, replacement of the ascending aorta when necessary 2, and intra-aortic filtration of atherosclerotic debris 2

In patients with severe aortic calcification requiring cardiac surgery, direct manipulation of the aorta may result in unrepairable aortic injury and/or distal embolization 2
Distinguish between simple aortic calcification and potential aortic aneurysm with calcification, as management approaches differ 6

Consider additional imaging studies to establish the extent of disease if surgical or catheter-based intervention is anticipated 1
For patients with symptoms or findings of myocardial ischemia, additional studies should be performed to determine the presence of significant coronary artery disease 1

Assess the extent of aortic calcification as part of pre-procedural planning, as it may affect device selection and delivery approach 4, 5
Consider that ascending aortic calcification is associated with increased risk of heart failure following TAVR 5
Evaluate for circumferential aortic calcifications (porcelain aorta), which may complicate device delivery 4