Valve-Sparing Root Replacement Following Congenital Heart Disease Repair: Lesion-Specific Technical Considerations

Valve-sparing root replacement (VSRR) is increasingly used for aortic root dilatation following congenital heart disease repair; however, technical differences between lesions are rarely described. Here, we present three adult cases of VSRR following prior repairs: perimembranous ventricular septal defect (VSD), annulus-sparing tetralogy of Fallot, and the Ross procedure. Unlike previous reports of subarterial VSD, in our two patients with prior VSD closure (including tetralogy of Fallot repair), the right coronary cusp (RCC) sinus was dissected without difficulty. No RCC prolapse or RCC-related repair was required, and only minor noncoronary cusp plication was performed. In the Ross case, reimplantation was performed along the autograft suture line without technical difficulty. Careful consideration of lesion-specific anatomy is essential for safe and effective VSRR following congenital repair.