Autologous Pericardial Cusps Within a Tubularized Bovine Pericardial Conduit for Right Ventricular Outflow Tract Reconstruction During the Modified Ross Procedure: A Technical Note

Background/Objectives: Limited availability of pulmonary homografts may restrict right ventricular outflow tract reconstruction after the Ross procedure. This technical note describes the geometric construction of a valved conduit composed of autologous pericardial cusps and a tubularized bovine pericardial patch. Methods: Autologous pericardium (approximately 10 × 8 cm) is treated with 0.9% glutaraldehyde for 10 min, and three size-4 cusps with triangular ears are fashioned using a Fehling template. A bovine pericardial patch (14 × 9 cm) is marked with the cusp attachment baseline, the commissural fixation line, and asymmetric tubularization lines. The cusp implantation field is divided into three equal segments, and each cusp is sutured to the mesothelial surface of the patch with a continuous suture, followed by commissural fixation. The patch is then tubularized, and valve competence is assessed by saline testing. Results: The conduit was constructed in approximately 60 min, in parallel with the main operation, and implanted in four patients undergoing a modified Ross procedure in 2025. Echocardiography on the first postoperative day showed no more than trace pulmonary regurgitation and no conduit obstruction. No conduit-related complications occurred; only early postoperative follow-up is available. Conclusions: The technique allows construction of a valved conduit from autologous and bovine pericardium using widely available materials. Currently, it demonstrates technical feasibility only; hemodynamic performance, safety, and durability remain to be established in larger studies with standardized follow-up.