The following is the summary of “Valve-sparing root replacement after the Ross procedure” published in the January 2023 issue of Thoracic and cardiovascular surgery by Hobbs, et al.

The Ross surgery is the gold standard of care for children and babies with aortic valve dysfunction. Due to the early age of these patients, valve-sparing aortic root replacement procedures offer advantages over the Bentall procedure when treating progressive neoaortic root dilatation and neoaortic insufficiency that can emerge after the Ross surgery. The purpose of this research is to report on their  progress in developing and implementing methods to replace the aortic root in a way that spares the aortic valve in this special population. Patients who underwent Ross procedure-related valve-sparing aortic root replacement between January 2001 and March 2021 were located. Clinical characteristics of these patients were examined during a retrospective chart review. Different valve-sparing aortic root replacement methods were also tested for their efficacy.

There were 42 patients who had received a Ross surgery as children and were now seeking reintervention for neoaortic root or valve pathology. 25 patients had successful valve-sparing aortic root replacement, while another 17 were candidates but ultimately had bioprosthetic or mechanical valve replacement instead. During valve-sparing aortic root replacement, patients were randomly assigned to 1 of 3 groups: group 1, traditional aortic root remodeling with or without suture annuloplasty (Yacoub technique; n=7), group 2, aortic root reimplantation (David technique; n=11), and group 3, modified root remodeling that also used a geometric annuloplasty ring (n=7). Both patients shared similar demographics and a similar assortment of medical conditions. There was a 14-year, 4-year, and 1-year mean follow-up for these three groups. Overall survival was excellent, with only one premature death in each group, one from hemorrhage in group 2 and 1 from cancer in group Neoaortic insufficiency led to aortic valve replacements in 8 individuals (7 in group 1 and one in group, but no one in group 3 needed further treatment. Preoperative neoaortic insufficiency was lower in patients who required valve replacement after valve-sparing aortic root replacement.

While postoperative neoaortic insufficiency was higher. When neoaortic insufficiency after surgery was more severe than mild, a new valve had to be implanted. Patients who have already undergone the Ross operation can safely undergo valve-sparing aortic root replacement. Compared to the conventional remodeling method, the results of a reimplantation are far more long-lasting. If the postoperative echocardiography shows any degree of neoaortic insufficiency more than mild, further valve repair procedures should be attempted. Modified remodeling using anatomically specific geometric ring annuloplasty is safe and yields good short-term effects; however, more extensive follow-up is required.