Autograft remodeling after the Ross procedure by cardiovascular magnetic resonance imaging: Aortic stenosis versus insufficiency

The Ross procedure is an excellent operation in non-repairable aortic regurgitation: insights and techniques

“…Several observations argue against this "genetic" hypothesis. First, recent cardiac magnetic resonance imaging studies have shown that when using a patientspecific tailored approach (see below), there is no early difference in autograft dimension, stiffness or geometry at one year between patients undergoing the Ross procedure for AS versus AR (32). This suggests that under the right conditions, the pulmonary autograft of patients with AR is capable of the same adaptive remodelling as that of patients with AS.…”

“…To mitigate this risk, we interpose a short Dacron graft between the autograft and the ascending aorta, which stabilizes the sinotubular junction (37). When employing this strategy, it is vital to keep the Dacron interposition graft as short as necessary, as we have observed that replacement of the ascending aorta with a Dacron graft, while stabilizing the sinotubular junction, results in a significant increase in autograft root stiffness (32), which may limit some of the benefits of the operation and lead to reduced autograft durability (22).…”

Commentary: The Ross procedure in a polyethylene terephthalate graft: Is everything OK in there?

“…Other stabilization techniques, especially in patients with AR have shown good results, whereas preserving autograft root geometry and dynamism. 5,6 The key will be continued systematic long-term clinical and echocardiographic follow-up of patients to tailor the optimal technique to each individual patient.…”

Commentary: Autograft remodeling after the Ross procedure. Keep a stiff upper lip

“…In this issue of the Journal, the Montreal group looks for the answer to these questions in their extensive experience with the Ross procedure. 3 Their aim in this study was to compare the biomechanical and morphologic remodeling at 1 year between cases done for AS or AI with cardiac magnetic resonance (CMR) imaging. Over the period from 2011 to 2016, their group did 210 Ross procedures.…”