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Modification to the Ross procedure to prevent autograft dilatation
Matthew Slater1, Irving Shen, Karl Welke
1Department of Pediatric Cardia Surgery, Doernbecher Children's Hospital, Portland, OR 97239, USA.
Summary
Dilatation of the pulmonary autograft after Ross procedure can be prevented by encasing it in a Dacron tube. This technique shows excellent short-term outcomes, preventing aortic root and valve dilatation in at-risk patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Devices
Background:
- Pulmonary autograft dilatation is a known complication after the Ross procedure for aortic valve replacement.
- Patients with aortic insufficiency, bicuspid aortic valves, or ascending aortic aneurysms are at higher risk.
- This dilatation can compromise the long-term function of the neoaortic root.
Purpose of the Study:
- To describe a novel technique for preventing pulmonary autograft dilatation.
- To evaluate the short-term outcomes of this technique in at-risk patients.
Main Methods:
- A technique involving encasing the pulmonary autograft within a Dacron tube graft.
- Coronary arteries are meticulously sutured to all layers of the autograft and Dacron construct.
- The procedure aims to create a non-dilatable neoaortic root.
Main Results:
- The technique is reproducible and demonstrated excellent short-term outcomes.
- No annular or sinotubular dilatation was observed in the follow-up period.
- Autograft valve function remained excellent.
Conclusions:
- Encasing the pulmonary autograft in a Dacron tube is an effective method to prevent dilatation.
- This technique may allow the Ross procedure to be safely extended to young adults.
- It provides a durable, non-dilatable neoaortic root, particularly beneficial when autograft growth is not required.