Valve-Sparing Aortic Root Replacement After Previous Ross

This video presents a twenty-two-year-old male born with congenital aortic stenosis secondary to a bicuspid aortic valve who had two previous sternotomies. He received an initial open aortic valvotomy at three weeks old.This was followed by Ross procedure with ascending aorta replacement when he reached fifteen. He developed severe right ventricular outflow tract obstruction secondary to pulmonary homograft dysfunction and calcifications. This is in addition to the progressive autograft root dilation. There was trivial autograft valve regurgitation.

The decision was made to proceed with a repeat operation with replacement of his pulmonary homograft and valve-sparing autograft root with a backup plan of a mechanical Bentall procedure.

The procedure was performed using the David V technique with a 30mm straight Dacron graft for the aortic root and a 26mm Dacron graft for the ascending aorta to create neo-sinuses. A 30mm 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 eleven days later.

A postoperative echocardiogram showed good biventricular function, trivial aortic valve regurgitation, and widely patent right and left ventricular outflow tracts. A follow-up computed tomography scan confirmed good a surgical result.

References

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

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