Valve Sparing Root Replacement After a Ross Procedure

N. Robinson¹, J. Dearani^2
1Mayo Clinic College of Medicine, Rochester, Minnesota ²Mayo Clinic, Rochester, Minnesota

Please explain the educational or technical point that this video addresses.: This video highlights the following education points:
- importance of pre-operative evaluation noting the mechanism of aortic valve regurgitation. In this case central regurgitation with annular dilation helped us understand that the patient would do well with a valve sparing root replacement.
-Importance of post operative follow up to identify issues after Ross including regurgitation and aneurysm at the previous suture line that necessitate further surgical intervention.
-importance of careful dissection on reoperation, and during mobilization of previously operated coronary buttons.
- importance and method of measuring the annulus and the height of the interleaflet triangle to know what size graft to use for the valve sparing root graft
- Highlights the importance of hard pledgets to prevent cinching of the annulus and changing dimensions of the root
- Highlights a technique of suspending and suturing the commissures
- Demonstrates the use of pericardial strips to buttress suture lines
- Demonstrates the RV to PA pulmonary homograft preparation and suturing.

Please provide a 250 word summary of the surgical video being submitted.: We present a 20-year-old female born with congenital aortic stenosis. She underwent balloon valvuloplasty as a newborn which was unsuccessful. She then underwent surgical valvotomy which was therapeutic but eventually progressed to severe regurgitation. In 2009, she underwent a Ross procedure with pulmonary cadaveric homograft. She was followed with serial imaging and in 2023 evaluation showed aortic root dilation to 44 mm, a mid-ascending aorta of 48 mm, and a pseudoaneurysm at the autograft-aorta suture line. Echocardiogram demonstrated pulmonary homograft conduit stenosis with a gradient of 33 mmHg and moderate neo-aortic valve regurgitation with a regurgitation mechanism of annular dilation. The patient underwent neoaortic valve sparing root and ascending aorta replacement with a 28 mm gelweave Valsalva root graft and replacement of the ascending aorta, up to the arch, with a 24 mm hemashield distal graft. The stenotic RV to PA homograft conduit was replaced using a 30 mm cryopreserved pulmonary homograft. The total bypass time was: 3 hours 08 minutes and the total cross-clamp time was: 2 hours 57 minutes. Circulatory arrest with retrograde cerebral perfusion time was 11 minutes. Post operative CT showed resolution of the aneurysm and the reconstructed aorta. Post operative echocardiogram demonstrated trivial aortic regurgitation and no stenosis with a good functioning RV to PA conduit.