Right-sided reconstruction during the Ross procedure—A technical perspective for long-term durability

The Ross procedure (RP) radically addresses aortic valve pathology with a biologically sound double-valve operation. It essentially involves replacing the patient's diseased aortic valve with the native pulmonary valve and reconstructing the right ventricular outflow tract (RVOT) with a suitable conduit (Figure 1). This is generally offered to patients who are younger than 50 years, with congenital bicuspid aortic valve being the most common etiology. Important contraindications include active rheumatic etiology, connective tissue abnormalities such as Marfan syndrome, osteogenesis imperfecta, etc, and abnormalities of the pulmonary valve including cuspal asymmetry, leaflet fenestration, bicuspid/quadricuspid valves, and other congenital abnormalities.