Modification to the Ross procedure to prevent autograft dilatation

Dilatation of the pulmonary autograft is a problem described following Ross procedure for aortic valve replacement. Patients at risk seem to be those with aortic insufficiency, bicuspid aortic valves, and those with aneurismal ascending aortas. We describe a technique for encasing the pulmonary autograft in a Dacron tube to prevent dilatation in these patients. This technique is reproducible and includes sewing the coronary arteries to all layers of the autograft and Dacron construct. Short-term follow-up shows excellent outcomes with respect to autograft valve function and lack of annular or sinotubular dilatation. This procedure may be useful for extending the Ross procedure to young adults, where autograft growth is no longer needed, to provide a non-dilatable neoaortic root.