[Combined valve surgery in end-stage renal disease patient with porcelain aorta and mitral annulus calcification].

A 66-year-old woman, who had been receiving regular hemodialysis for 11 years, was referred to our hospital because of heart failure due to combined valve disease complicated by porcelain aorta and mitral annulus calcification. We performed ascending aortic replacement under hypothermic arrest, and double valve replacement and tricuspid valve annuloplasty during rewarming. It was noted that the annulus of P3 of mitral valve had been replaced with atherosclerotic plaque containing calcification. We did not perform débridement. We placed non-everted horizontal mattress sutures from the left ventricle to the atrium on the anterior annulus and P1 to P2 annulus, and everted horizontal mattress sutures on the left atrial wall close to the calcified P3 annulus. Then, we successfully replaced the mitral valve with a 23-mm St. Jude Medical valve in a supra-annular position. The patient was discharged from the hospital 44 days after the operation.