ALT Surgical MV repair is associated with excellent outcomes even in older patients. Ultimately, pursuing surgical MV repair preserves optionality. SHR, Subhazard ratio; CI, confidence interval; HR, hazard ratio; MV, mitral valve; MR, mitral regurgitation.

ALT A retrospective cohort study was conducted in which 129 adult patients with bicuspid aortic valves underwent the Ross procedure with either a standard root inclusion technique or a modified technique whereby the pulmonary autograft is wrapped in a vascular conduit. Primary outcomes were survival and need for pulmonary autograft reintervention. Competing risk analysis demonstrated the wrapped technique reduced pulmonary autograft reintervention.

ALT (Video): Ross procedure with the pulmonary autograft inclusion technique in an adult patient with critical aortic stenosis due to a calcified bicuspid aortic valve. The coronary buttons are created, and the diseased aortic valve excised. The pulmonary trunk is divided, and the pulmonary valve excised en bloc from the right ventricular outflow tract. The pulmonary autograft is sized with a dilator. A polyethylene terephthalate graft 2 mm larger than the pulmonary autograft is chosen. The autograft is secured within the graft just below the valve leaflets. The distal autograft is secured to the graft. The wrapped autograft is sutured to the left ventricular outflow tract with a running technique, followed by coronary button reimplantation and the proximal anastomosis. An appropriately sized pulmonary homograft is then used to reconstruct the right ventricular outflow tract.