Ross Procedure Renaissance: A Contemporary Review of Patient Selection, Technique, and Long‐Term Outcomes in Adults

Figure 1. Failed prosthetic valves. Examples of prosthetic valve failures by stenosis, regurgitation or both. Top row: example of mechanical valves. Bottom row: example of bioprosthetic valves.

Figure 2. Echocardiographic images of failed prosthetic valves. A, Transesophageal echocardiogram showing prolapse of 2 bioprosthetic valve leaflets (arrows) with severe transvalvular regurgitation. B, Echocardiogram and noncontrast computed tomography demonstrating limited leaflet mobility in a bileaflet mechanical aortic valve with severe aortic stenosis. C, Echocardiogram showing severe aortic stenosis with a mean gradient >50 mm Hg; computed tomography angiography revealed minimal leaflet calcification. D, Echocardiogram revealing combined severe stenosis and moderate regurgitation in a bioprosthetic aortic valve; the leaflets were thickened and immobile without calcification, and perforations were noted.

Figure 3. Proposal of algorithm for post–Ross procedure management. PPI indicates proton pump inhibitor; SBP, systolic blood pressure; and TTE, transthoracic echocardiograhy.