A Novel, Simplified Protected Ross Technique: The “Seattle Shawl” Procedure

Post Ross procedure dilation of the pulmonary autograft (neo-aorta) is a major long-term draw back that has been dealt with in many ways, including strict blood pressure control for one year, ring and suture annuloplasty techniques, and autologous and prosthetic external graft stabilization techniques. These techniques are associated with varying technical difficulties and can add considerable time to the overall operation. The authors report their outcomes with their Seattle shawl modification of a protected Ross technique performed for bicuspid aortic valve with promising early results. This technique, described in detail, modifies the skirt of a Valsalva graft with keyholes for coronary button implantation. The authors also discuss their algorithm for choosing this technique over other conventional established approaches.