Aortic valve replacement in a patient with a retrosternal gastric tube and porcelain aorta.

A 66-year-old man with severe aortic stenosis had previously undergone esophagectomy with retrosternal gastric tube (GT) reconstruction for esophageal cancer. A chest computed tomography scan demonstrated severe aortic calcification, and we treated him with median sternotomy. A small upper laparotomy was made, and the surface of the GT was detected. The posterior and right sides of the GT were dissected, and the pericardium was then opened. An aortic cross clamp was performed in the least calcified lesion of the ascending aorta, and an aortotomy was performed just above the sinotubular junction. The aortic valve was successfully replaced with a mechanical valve.