**1. Introduction**

Valve replacement has been the standard treatment for aortic stenosis until the develop‐ ment of transcatheter aortic valve implantation (TAVI). Although TAVI provides a treatment with fairly acceptable outcomes for patients with high surgical risk, aortic valve replacement remains essential even in the TAVI era, because surgical treatment is indicated when TAVI cannot be performed due to a small aortic annulus or inappropri‐ ate access route. In addition, surgical treatment may be necessary when complications develop during TAVI procedures. Therefore, a more meticulous procedure is required for surgeons. With an increasing number of elderly patients who need surgical treatment and are at high risk due to aging, comorbidities, or medications such as steroids or antiplate‐ let drugs, trivial pitfalls during surgery can lead to catastrophic results. Furthermore, many patients with hemodialysis and marked systemic calcification require aortic valve surgery in Japan [1].

Complications encountered during surgery for aortic stenosis can be associated with catastrophic events such as myocardial infarction, cerebral embolism or aortic dissection. This is because a calcified aortic valve rarely exists alone, but is often associated with marked and diffuse calcification in the aorta, coronary arteries, mitral valve or even cerebral vessels [2]. The goal of surgical treatment is to implant a prosthetic valve of adequate size in each individual patient without perivalvular leak, while avoiding undesirable complications such as stroke, cardiac events or bleeding. This chapter is devoted to the tips and pitfalls in aortic valve replacement of calcified aortic valves with a discussion of preoperative and intraoperative strategies to achieve the best possible outcomes.

© 2013 Orihashi; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
