Total autologous reconstruction of the right and left ventricular outflow tracts: the case for the modified Ross-Ozaki procedure

Abstract

The Ross procedure continues to be the best procedure to address unrepairable aortic valve pathology, especially in young adults. The Achilles heel of this procedure has been aortic root dilation and the potential need for a reoperation that may be associated with slightly increased risks in addition to the need for intervention on the pulmonary outflow tract. Modifying the Ross procedure by autograft inclusion inside a Dacron graft seems to have the potential advantage of stabilizing the autograft diameter, which may be associated with improved durability and decrease the need for future intervention. Although the long-term data are satisfactory, the pulmonary homografts are costly and have limited availability, so the need for alternate options for reconstruction of the right ventricular outflow tract exists. Utilization of the autologous pericardium in the reconstruction of neo-pulmonary leaflets may be considered an alternative to other pulmonary valve reconstruction options. We present a few different modifications to the Ross procedure that may have the potential of being more reproducible and more cost effective, especially in areas of the world where homografts and bioprosthetic valves are not readily available.

Keywords: Aortic stenosis; Left ventricular outflow tract obstruction; Ozaki procedure; Pulmonary Valve; Pulmonary Valve Replacement; Ross procedure; Unicuspid aortic valve.