Again, mobilizing the coronary buttons prior this step facilitates the ease and safety of dissection. The pulmonary root is now dissected circumferentially, taking care to avoid the left main coronary artery and the left anterior descending artery. The left and right coronary buttons are mobilized as this facilitates the next step of the procedure. Once the decision to proceed with the Ross operation has been made, we re-inspect the aortic root. The pulmonary valve is inspected and assessed for use as the autograft valve. After inspecting the aortic valve as mentioned above, the main pulmonary artery is transected just proximal to the left and right pulmonary artery bifurcation. Autograft harvestingīefore instituting cardiopulmonary bypass, we use a Hemashield sizer to estimate the external diameter of the pulmonary artery at the level of the annulus. ![]() After cardioplegic arrest, the aorta is transected just above the sinotubular junction and the aortic valve is inspected and the aortic annulus is sized. The operation is performed via median sternotomy, on moderate hypothermic cardiopulmonary bypass with aortic and bicaval cannulation. Technique Cardiopulmonary bypass and aortic valve inspection We described a technique in 2005 ( 6) to address this problem, in which we place the entire autograft in a Dacron tube which makes it theoretically unlikely, if not impossible, for it to dilate-the reinforced Ross procedure. Autograft dilation, when occurs, is not limited to the annulus, and involves the entire autograft. ![]() ![]() As a result, there have been reports of “wrapping” the autograft with pericardium or ascending aorta (inclusion technique) or with Dacron or Teflon felt at the annular level, but these do not tend to provide support for the entire autograft ( 3- 5). ![]() Patients with bicuspid aortic valves and dilated ascending aortas or patients with dilated aortic roots and primarily aortic insufficiency have been considered the highest risk groups for autograft dilation and neoaortic insufficiency in some series ( 1, 2). The Ross operation for aortic valve replacement continues to be a controversial option because of concerns related to late autograft dilation and progressive neo-aortic regurgitation. Keywords: Aortic valve/surgery blood vessel prosthesis implantation/methods dilation, pathologic/prevention and control heart valve diseases/surgery
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