Late Pulmonary Autograft Dilation: Can We Make a Good Operation Great? The Tailored Approach

Ismail El-Hamamsy, Luca A. Vricella

Research output: Contribution to journalReview articlepeer-review


While it is the main viable option in the growing child and young adult, the Ross procedure has expanded its applicability to older patients, for whom long-term results are equivalent, if not superior, to prosthetic aortic valve replacement. Strategies aiming at mitigating long-term autograft failure from root enlargement and valve regurgitation have led some to advocate for root reinforcement with prosthetic graft material. On the contrary, we will discuss herein the rationale for a tailored approach to the Ross procedure; this strategy is aimed at maintaining the natural physiology and interplay between the various autograft components. Several technical maneuvers, including careful matching of aortic and autograft annuli and sino-tubular junction as well as external support by autologous aortic tissue maintain these physiologic relationships and the viability of the autograft, and could translate in a lower need for late reintervention because of dilation and/or valve regurgitation.

Original languageEnglish
Pages (from-to)42-46
Number of pages5
JournalSeminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual
StatePublished - Jan 2024


  • Ross procedure
  • aortic regurgitation
  • pulmonary autograft
  • reoperation


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