Externally-Supported Ross Procedure and Konno Aortoventriculoplasty With Sinus of Valsalva Graft

The advantage of the Ross procedure over bioprosthetic or mechanical valve options are the superior hemodynamics, resistance to infection, durability, and lack of thrombogenicity. External support of the thin-walled pulmonary autograft aims to mitigate the rate of dilatation due to exposure to arterial pressures. The Sinus of Valsalva graft is used in particular to more closely mimic the shape of and minimize distortion of the autograft. The video demonstrates Dr James Tweddell’s unique method of performing this procedure, along with how to manage an externally-supported autograft in a patient with a hypoplastic aortic annulus requiring a Konno aortoventriculoplasty. Dr Tweddell’s innovative technique in particular has shown excellent mid-term results with minimal neo-aortic root dilation and re-intervention (1). The patient was a 28-year-old man with a history of a bicuspid aortic valve. He had previously undergone balloon aortic valvuloplasty twice in the catheterization lab. Prior to surgery, the patient was found to have severe aortic stenosis (peak systolic velocity 4.4 m/sec ) with moderate aortic aortic valve regurgitation (regurgitant fraction ~20%), and mild left ventricular hypertrophy. The patient had a vasovagal or syncopal episode during his preoperative testing requiring CPR that resulted in prompt return of a perfusion. The patient underwent an externally-supported Ross procedure and Konno aortoventriculoplasty with Sinus of Valsalva graft. The patient did well postoperatively and was discharged home on postoperative day three.

Reference

Riggs KW, Colohan DB, Beacher DR, Alsaied T, Powell S, Moore RA, et al. Mid-term outcomes of the supported Ross procedure in children, teenagers, and young adults. Semin Thorac Cardiovasc Surg. 2020;32(3):498-504.

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