Stabilizing of Free-Standing Autograft in Ross Operation by External Wrapping

Objective: We describe a new method to prevent autograft dilatation in Ross operation.

Methods: We performed a retrospective analysis of our hospital database from 2013 till June 2016 including all patients who underwent Ross- or Ross-Konno-procedure with concomitant aortic root wrapping. Patients with previous cardiac surgery were excluded from the analysis. The end-points of the study were perioperative mortality, survival and freedom from reinterventions.

Results: Since 2013 six patients underwent combined surgery with a Ross procedure (n = 5) and a Ross-Konno procedure (n = 1). Concomitant wrapping of the aortic root was performed with Gore-Tex (n = 5) or autologous Glutaraldehyde treated pericardium in one patient. The median age was 6 years (8 months–22 years), with a median weight of 23.5 kg (6–81 kg) and height of 122.5 cm (70–185 cm). Indications for surgery were mostly combined aortic valve stenosis and regurgitation (n = 4) and aortic valve stenosis (n = 2) with a monocuspid valve in 2 patients and bicuspid valve in 3 patients. At the time of surgery 5 patients had already developed dilatation of the ascending aorta or aortic root with a mean z-score of +4.5 in these patients. Surgery was successfully performed in all patients with good postoperative results. There was no early mortality within 30 days after surgery and so far no reintervention had to be performed. Mean follow-up is 3.38 years.

Conclusion: Wrapping of autograft as part of the Ross- and Ross-Konno-operation is easily applied and results in reproducible prevention of root dilation even in patients with a dilated aortic root who were otherwise considered as unfavorable Ross candidates.