A novel, simplified protected Ross technique: The "Seattle shawl" procedure

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Surgical Innovation

Background:

• The Ross procedure involves using a patient's own pulmonary valve (autograft) to replace a diseased aortic valve.
• Long-term challenges after the Ross procedure include pulmonary autograft dilation and subsequent aortic regurgitation.
• Existing interventions to mitigate autograft dilation include annuloplasty rings or Dacron graft inclusion.

Purpose of the Study:

• To present a novel technique for pulmonary autograft protection during the Ross procedure.
• To evaluate the early outcomes of a modified Dacron wrap technique, termed the "Seattle shawl", for autograft stabilization.

Main Methods:

• A patient-specific tailored algorithm was developed for autograft protection in 2022.
• The "Seattle shawl" technique utilizes a modified Valsalva graft, keyholed for coronary implantation, wrapped around the pulmonary autograft.
• The procedure was performed on 6 adult patients with bicuspid aortic valves and severe aortic regurgitation.

Main Results:

• Mean follow-up was 11.8 months (range, 4-17 months).
• No perioperative strokes, reinterventions, or mortalities were observed.
• All patients demonstrated mild or less aortic regurgitation post-procedure, with reduced aortic root diameters.

Conclusions:

• Pulmonary autograft dilation is a significant long-term challenge after the Ross procedure in adults.
• The "Seattle shawl" technique offers a straightforward and promising method for autograft protection.
• Early outcomes suggest this novel technique effectively mitigates aortic regurgitation and stabilizes the autograft.