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Redo Reinforced Ross: A Step-by-Step Guide
This video presents the case of a thirty-seven-year-old woman with a history of aortic valve replacement and reconstruction of her aortomitral fibrosa and anterior leaflet of the mitral valve due to endocarditis. A bioprosthetic valve was used at the time due to concerns regarding compliance with coumadin. She is fully rehabilitated from drug abuse and is planning to have children. She was referred to the surgical team with congestive heart failure and found to have severe SVD of her bioprosthesis.
In addition to standard workup for sternal reentry, special emphasis was paid to the proximity of the RVOT and PA to the sternum, as well as coronary anatomy. Anomalous coronary courses, especially intramural, interarterial, or an LAD crossing the RVOT should be noted if present, and may require technique modification. Pulmonary valve function was also assessed by intra-operative TEE. The team avoided using PA catheters before and after surgery.
This video illustrates the reinforced Ross procedure with step-by-step narration. Meticulous attention to auto-graft geometry was critical in this case. Preventing autograft dilatation enhances durability and was achieved through stabilizing the neo-basal ring and neo-STJ using Dacron grafts.
The reinforced Ross procedure is an excellent option in relatively young and healthy patients with aortic valve pathology. Technical details are important for success and durability.
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