Valve Sparing Aortic Root Replacement After Previous Ross
A 22-year-old male born with congenital aortic stenosis secondary to a bicuspid aortic valve, had two previous sternotomies. An initial open aortic valvotomy at three weeks of age, followed by Ross procedure with ascending aorta replacement at age 15 years old. He developed severe right ventricular outflow tract obstruction secondary to pulmonary homograft dysfunction and calcifications, in addition to progressive autograft root dilation. There was trivial autograft valve regurgitation.
Decision was made to proceed with repeat operation with replacement of his pulmonary homograft and valve-sparing autograft root replacement with a backup plan of a mechanical Bentall procedure.
The procedure was performed using David V technique with a 30 mm straight Dacron graft for the aortic root and a 26 mm Dacron graft for the ascending aorta to create neo-sinuses. A 30 mm pulmonary homograft was used to reconstruct the right ventricular outflow tract. This was done under normothermic cardiopulmonary bypass with aortic and bicaval cannulation.
The patient was extubated at the end of the procedure, and was discharged 11 days later.
Postoperative echocardiogram showed good biventricular function and trivial aortic valve regurgitation, widely patent right and left ventricular outflow tracts. Follow-up computed tomography scan confirmed good surgical result.
1. Ross DN. Replacement of the aortic and mitral valves with a pulmonary autograft. Lancet. 1967 Nov 4;2(7523):956-958.
2. David TE, Ouzounian M, David CM, Lafreniere-Roula M, Manlhiot C. Late results of the Ross procedure. J Thorac Cardiovasc Surg. 2019 Jan;157(1):201-208.
3. Liebrich M, Weimar T, Tzanavaros I, Roser D, Doll K.N, Hemmer W.B. The David procedure for salvage of a failing autograft after the ross operation. Ann Thorac Surg. 2014; 98: 2046-2052
4. Luciani G.B, Lucchese G, De Rita F, Puppini G, Faggian G, Mazzucco A. Reparative surgery of the pulmonary autograft: experience with Ross reoperations. Eur J Cardiothorac Surg. 2012; 41: 1309-1314