The Externally-Supported Ross Procedure With Konno Aortoventriculoplasty

Abstract

The Ross procedure remains the best aortic valve replacement option for children and young adults due to the superior hemodynamics, resistance to infection, durability, and lack of thrombogenicity when compared to bioprostheses and mechanical valve options. In particular, avoiding anticoagulation in this patient population is especially advantageous. Modifications to the technique have been developed to ameliorate the most common problem following the Ross procedure: dilatation of the autograft with development of aortic regurgitation. External support of the autograft with a Dacron tube graft have demonstrated excellent early- and mid-term outcomes. In cases of left ventricular outflow tract obstruction, the externally supported Ross procedure can be combined with a Konno aortoventriculoplasty with a few simple modifications. This paper describes the technique of the externally supported Ross procedure with a Sinus of Valsalva Dacron graft (Gelweave Terumo Cardiovascular Group, Ann Arbor, MI) in patients with aortic stenosis. This paper will specifically address the subset of patients with hypoplastic aortic annuli requiring a Konno aortoventriculoplasty.