Ross Procedure After Previous Aortic Valve Repair in an Adult
After repeat median sternotomy, cardiopulmonary bypass (CPB) was
initiated via central aortic and bicaval cannulation. Aortic cross clamp
was applied and antegrade cardioplegia was administered. The pulmonary
autograft was harvested using electrocautery and trimmed. The aortic
root was prepared and coronary buttons were harvested. The autograft was
implanted using running 5/0 prolene suture supported with bovine
pericardial strips, followed by reimplantation of the coronary buttons
in the corresponding sinuses of Valsalva of the neo-aortic root. The
authors kept the native noncoronary sinus in place as they believe it
provides a hemostatic layer and support for the autograft in this area.
To stabilize the neo-sinotubular junction, they replaced a portion of
the ascending aorta using a 24 mm hemashield graft.
decellularized 30 mm pulmonary homograft was used to restore the right
ventricular to pulmonary arterial confluence continuity. This was
followed by reconstruction of the distal graft to native aortic
anastomosis. The heart was then de-aired and the cross clamp was
removed. The patient regained his normal sinus rhythm and was weaned off
CPB without difficulty. The aortic cross clamp time was 127 minutes,
and the cardiopulmonary bypass time was 166 minutes. The patient was
extubated a few hours after surgery, received no transfusions, and
remained in normal sinus rhythm.
The rest of his
hospital course was uneventful and he was discharged home on the sixth
postoperative day. Pre-dismissal transthoracic echocardiography showed
unobstructed flow across the left ventricular outflow tract with no
neo-aortic valve regurgitation or stenosis. The peak gradient across the
neo-aortic valve was 4 mm Hg, and it was 17 mm Hg across the pulmonary
homograft, and the ventricular function remained normal.
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