Ross Procedure using the Inclusion Technique

R. Humar¹, A. Trento², M. Bowdish^3
1Cedars-Sinai, West Hollywood, California ²Cedars-Sinai Medical Center, Los Angeles, California ³Cedars Sinai Medical Center, La Canada, California

Please explain the educational or technical point that this video addresses.: The Ross procedure involves harvesting the pulmonary autograft and implanting in the aortic position. Overtime, the pulmonary autograft as a free-standing root implantation is prone to significant root dilation. External support has been demonstrated to warrant longevity of the autograft and can be performed using a Dacron jacket or autologous native aortic tissue. This video details the operative techniques of supporting the autograft within the intact native aortic root.

Please provide a 250 word summary of the surgical video being submitted.: The Ross procedure consists of replacing the diseased aortic valve with the patient's own pulmonary valve and implanting a human cadaver valve in the pulmonary position. This can be performed with an inclusion technique to prevent dilation of the autograft.

After bicaval cannulation, the heart was arrested cardioplegia. The aorta was opened obliquely and extended towards the non-coronary commissure to facilitate the inclusion technique.

After transecting the pulmonary artery at the bifurcation, the pulmonary valve was examined to confirm its morphology. The pulmonary autograft was dissected out and sharply harvested being cautious to avoid the LAD and the first septal perforator on the lateral side.

The noncoronary sinus was extended towards the aortic annulus to facilitate the inclusion technique. The pulmonary autograft was implanted in the aortic position. The 2 coronary ostia were reimplanted in orthotopic position. Coronary buttons were not created as the ostia were reimplanted using the root inclusion technique. The non-coronary sinus was closed longitudinally to reinforce the pulmonary autograft.

After preparing the homograft, the distal anastomosis to the pulmonary artery was completed. The distal aortic was then completed followed by the proximal homograft anastomosis to the right ventricular outflow tract.

After deairing, removing the cross clamp and weaning off of cardiopulmonary bypass, all anastomotic lines were investigated and the function of the heart was assessed. TEE confirmed proper function of the neo-aortic valve. The patient had an unremarkable ICU course and was discharged on post operative day 6.