Pulmonary autograft reinforcement to prevent dilatation and subsequent neo-aortic valve regurgitation was reported. However, the late functional outcome of the native pulmonary valve inside a rigid Dacron conduit requires to be documented. We aimed to assess the results of modified Ross procedure associated with autograft reinforcement reimplantation technique.

Outcomes of 61 consecutive patients who underwent Ross procedure with reinforcement between 2009 and 2021 were analyzed. Majority of cases has presented with mono or bicuspid aortic valve (n=52; 85%), predominant aortic valve regurgitation (n=47; 77%) and dilatation (>30mm) of the ascending aorta (n=33; 54%). Forty-seven patients (77%) had prior aortic valve procedure including 38 surgical repair (62%) and 9 balloon dilatation (15%). Pulmonary autograft was reimplanted in a Dacron conduit of a median diameter=25.6mm (ranges: 20–30) using Tirone David's valve sparing aortic root replacement technique.

No death occurred. Median age at procedure was 16.8 years (range: 6–38). Two patients (3%) required early neo-Aortic root revision, one other was reoperated later on resulting in neo-aortic valve replacement in 3 (4.9% IC 95% [0.34%; 12.7%]) because of respectively infective endocarditis, left ventricular false aneurysm and leaflet perforation. Six patients required right ventricular outflow conduit replacement including one percutaneous replacement. At mean 66±50.5 months postoperatively, the survival rate with freedom from reintervention was 83% [71.9; 93.5] and the deterioration of the initial neo-Aortic valve function (regurgitation or stenosis) was not observed (Fig. 1).

Autograft reinforcement by means of reimplantation technique allowed to extend the indications for Ross procedure to all patients requiring Aortic valve replacement and prevented neo-Aortic root dilatation. Failures were early and rare, and late controls confirmed the stability of the neo-aortic valve function in follow-up.