Sustitución valvular aórtica con autoinjerto pulmonar (técnica de Ross)

The technique of aortic valve replacement with the pulmonary autograft was introduced by Donald Ross more than 30 years ago. It is probably one of the best operations designed to replace the aortic valve. Its main indication is aortic valve disease in young patients with life expectancy of more than 20 years. It is particularly attractive in young fertile females or for those with intense physical activity. Formal contraindications are collagen or immune diseases and rheumatic fever seems to be a relative contraindication. After the initial description, some technical modifications have been introduced until the full root replacement. After 1998, the International Spanish Registries of the Ross operation have been created. This operation has four well defined steps: the resection of the diseased aortic valve; the harvesting of the autograft; the implantation of the autograft in the aortic position, and the reconstruction of the right ventricular outflow tract with a pulmonary homograft. A meticulous surgical technique is required and we recommend the use of an autologous pericardial strip to reinforce the proximal suture line. Platelet transfusion is also recommended at the end of the operation as well as intraoperative control with transesophageal echocardiography.