Aortic Valve Replacement in Children using a Pulmonary Autograft: How I Teach the Ross Procedure
Amanda R. Stram, MD, Jeremy L. Herrmann, MD, John W. Brown, MD.
Indiana University School of Medicine, Indianapolis, IN, USA.
Aortic Valve Replacement in Children using a Pulmonary Autograft: How I Teach the Ross Procedure
Objective: Prosthetic aortic valve replacement in children can pose significant challenges due to limited availability of appropriate graft sizes and growth constraints of prosthetic material. The Ross procedure eliminates most of these limitations by utilizing the patient’s own pulmonary valve in the aortic position, which can grow with the patient and does not require anticoagulation.
Methods: We demonstrate the Ross procedure in a 17-year-old male with a bicuspid aortic valve and moderate-to-severe stenosis and mild-to-moderate plus aortic insufficiency. He also had a discrete subaortic ridge and an aneurysmally-dilated ascending aorta. We placed his 26mm pulmonary autograft in the aortic position and used a 32mm decellularized pulmonary allograft (CryoLife; Kennesaw, GA) to replace his pulmonary valve. We also performed a subaortic membrane resection and a replacement of his dilated ascending aorta with a 28mm Hemashield Dacron graft (Boston Scientific; Spencer, IN) that stabilized the Ross sinotubular junction.
Results: The postoperative echocardiogram demonstrated normal cardiac function and no residual left ventricular outlet tract obstruction. He was discharged in good condition on postoperative day five.
Conclusion: The Ross procedure is an excellent method for aortic valve replacement in children, adolescents and young adults. Attention to technical and perioperative details can eliminate many of the late problems for which the Ross AVR has been criticized. This presentation will focus on the technical and perioperative points to prevent late Ross complications.
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