How-I-Do-It: The Ross Procedure in Adolescents With Bicuspid Aortic Valve, Aortic Regurgitation and a Dilated Annulus

While the Ross procedure provides optimal clinical outcomes for young patients with aortic valve disease, the presence of preoperative aortic regurgitation (AR) with a dilated aortic annulus have long been recognized as independent predictors of early autograft failure. While this had led many to abandon the Ross procedure in this setting, we sought to specifically address the clinical and anatomic features that are unique to patients with severe AR, namely a dilated aortic annulus, aortic/pulmonary annular mismatch, ascending aortic dilatation and persistent hypertension early after surgery. Using a tailored surgical approach along with strict blood pressure control postoperatively, we believe that many of the concerns with the Ross procedure in this setting can be successfully mitigated. Importantly, these adjuncts do not compromise the dynamism of the autograft root, an important feature for the long-term benefits of the Ross procedure, especially in young and adolescent populations. In this article, we describe in detail our Ross technique in the setting of young patients with bicuspid AR and a dilated aortic annulus.