Pericardial collar modification for Ross procedure

Although the surgical technique of the Ross operation has been improved over the years, there are still some technical difficulties: (1) The possibility of damage to first septal artery during harvesting and reconstruction of right ventricular outflow tract (RVOT). (2) Weak posterior anastomotic area during RVOT reconstruction. (3) Persistent bleeding from septal dissection site of pulmonary autograft. To deal with these difficulties, we used a 1-cm wide pericardial strip (pericardial collar) which was sutured to epicardium at the posterior and septal edge of the RVOT. The conduit used for the reconstruction of pulmonary outflow was then sutured to this pericardial strip at the posterior part of the anastomosis. We found this technique very useful to create a safe and strong margin for the posterior suture line. Persistent bleeding from septal dissection site can be also avoided using this modification by diverting the bleeding site into the right ventricular cavity.