American Association of Plastic Surgeons

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Technique of the Reinforced Ross procedure
Ashok Muralidaran, Irving Shen.
Oregon Health & Science University, Portland, OR, USA.

Objective(s): To describe a technique of reinforcing the pulmonary valve root during the Ross procedure to prevent future autograft dilation.
Methods: The harvested pulmonary autograft is encased in a Dacron sleeve trimmed to match the autograft height. The Dacron graft is sized 3 to 4 mm wider than the autograft diameter. The inferior (inlet) end of the autograft is secured using continuous polypropylene suture to the Dacron graft and the superior end is secured using interrupted sutures, one at each commissure and two equidistantly placed between the commissural ones. This composite autograft is then sutured to the aortic annulus after debriding all native aortic root and valve tissue using continuous polypropylene interrupted multiple times. Slits or holes are made at the superior end corresponding to coronary button landing sites followed by reimplantation of the coronary arteries ensuring that the continuous polypropylene suture line includes both layers of the composite autograft. The final distal anastomosis between the composite autograft and the ascending aorta is then performed.
Results: This reproducible technique encases the pulmonary autograft in a Dacron sleeve, mechanically preventing delayed dilation and the associated valve dysfunction.
Conclusions: Aortic valve replacement options in older children and adults, especially in the setting of bicuspid aortic valve and aortic dilation are often limited to mechanical or bioprosthetic valves. The Ross operation is seldom offered due to potential long term autograft dilation and consequent valve insufficiency. Autograft reinforcement addresses this concern, reintroducing the Ross procedure as a long term viable option in this population.


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