The Ross Procedure: Imaging, Outcomes and Future Directions in Aortic Valve Replacement

Figures

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  Figure 1. Transthoracic echocardiography Parasternal short axis view; Panel (A): Degenerative homograft cusps (yellow arrow, diastolic phase); Panel (B): Degenerative homograft cusps (yellow arrow, systolic phase); Panel (C): color Doppler showing the regurgitation originating from the right pulmonary artery suggestive of severe regurgitation; Abbreviations: RVOT: Right ventricular outflow track, RA: Right atrium, AoV: Aortic valve, MPA: Main trunk of pulmonary artery, RPA: Right main branch of pulmonary artery.

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  Figure 2. Panel (A) Parasternal short-axis (PSAX) view at aortic valve level short-axis (PSAX) view showing severe homograft stenosis with degenerative homograft cusps (yellow arrow) RVOT and MPA. Panel (B); color Doppler demonstrating systolic flow acceleration starting at the level of pulmonic homograft (yellow arrow) indicating pulmonic valve stenosis (PS). Panel (C); Continuous-flow (CW) Doppler across the pulmonic valve showing severe PS with peak and mean gradients of 69 and 42 mmHg, respectively; Abbreviations: AoV: aortic valve, RVOT: right ventricle out-flow tract, MPA: main pulmonary artery.

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  Figure 3. Cardiac magnetic resonance (CMR) with oblique sagittal stack cine cuts at different level showing pulmonic homograft stenosis. Green arrow showing defacing (showing significant stenosis); Abbreviations: PV: pulmonary valve, RVOT: right ventricular outflow track, RA: right atrium. RV: right ventricle, LA: left atrium.

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  Figure 4. This figure presents a systematic review encompassing three distinct patient populations from studies reporting outcomes in adult patients aged between 18 and 55 years who have undergone the Ross procedure [34], bioprosthetic aortic valve replacement [35], and mechanical aortic valve replacement [36]. Panel (A) illustrates the aggregated early mortality rates, represented on the Y-axis, across different cohorts subjected to the three aforementioned surgical procedures. Panel (B) displays the aggregated annual late mortality rates as percentages. Panel (C) delineates the lifetime risk percentages for re-intervention in the Ross procedure, with separate data for the autograft in the aortic position and right ventricular outflow tract (RVOT) surgical interventions, as well as for bioprosthetic and mechanical aortic valve replacements. Panel (D) involves pooled data input into a microsimulation model, estimating the life expectancy, in years, of a 45-year-old patient following different aortic valve replacement surgeries. These estimates are compared (highlighted in red) with the projected life expectancy, post-45 years, of the general population that has not undergone any surgical…