BACKGROUND: Aortic valve damage is the most common valvular heart disease in developed countries. The Ross procedure is an alternative to the aortic valve replacement with a prosthesis, providing a longer survival without reoperation and without the need for anticoagulation therapy. The unavailability of homografts for the pulmonary valve replacement is one of the limiting factors for a more common utilization of this therapeutic method. CASE SUMMARY: This case report presents a 35-year-old Caucasian male with a bicuspid aortic valve and severe aortic regurgitation. The patient underwent the Ross procedure with the stabilization of the aortic ring and sinotubular junction. A tubular prosthesis was created from the bovine pericardium, into which three neo-cusp valves were fashioned from autologous pericardium. The new pulmonary conduit was sutured distally to the distal pulmonary trunk and proximally to the right ventricular outflow tract. Four months post-operatively, the follow-up echocardiographic examination documented that the valve in the aortic position had no regurgitation, a maximum velocity of 1.25 m/s, and a peak gradient of 6.25 mmHg. The valve in the pulmonary position showed a trace regurgitation and mean pressure gradient of 13 mmHg. DISCUSSION: The combination of the modified Ross procedure with neo-cuspidalization according to Ozaki for a new pulmonary valve thus offers hope for an extended survival without reoperation in paediatric and non-elderly adult patients with an aortic valve dysfunction. This technique is additionally applicable by cardiac surgery centres without access to pulmonary homografts.

1 Surgery Department Cardiovascular Surgery General University Hospital and 2nd Faculty of Medicine Charles University 12808 Prague Czech Republic

Department of Cardiac Surgery Na Homolce Hospital 15030 Prague Czech Republic

Department of Heart Surgery East Slovak Institute of Cardiovascular Diseases and Medical Faculty University of Pavol Jozef Šafárik 04011 Košice Slovakia

Zobrazit více v PubMed

Benfari  G, Essayagh  B, Michelena  HI, Ye  Z, Inojosa  JM, Ribichini  FL, et al.  Severe aortic stenosis: secular trends of incidence and outcomes. Eur Heart J  2024;45:1877–1886. PubMed

Vahanian  A, Beyersdorf  F, Praz  F, Milojevic  M, Baldus  S, Bauersachs  J, et al.  2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J  2022;43:561–632. PubMed

Concha  M, Aranda  PJ, Casares  J, Merino  C, Alados  P, Munoz  I, et al.  The Ross procedure. J Card Surg  2004;19:401–409. PubMed

Sharifulin  R, Bogachev-Prokophiev  A, Demin  I, Afanasyev  A, Ovcharov  M, Pivkin  A, et al.  Allografts and xenografts for right ventricular outflow tract reconstruction in Ross patients. Eur J Cardiothorac Surg  2021;59:162–169. PubMed

Abeln  KB, Froede  L, Giebels  C, Schafers  HJ. Durability of right ventricular conduits in the Ross procedure. J Thorac Cardiovasc Surg  2025;169:1306–1314. PubMed

Chauvette  V, Bouhout  I, Tarabzoni  M, Pham  M, Wong  D, Whitlock  R, et al.  Pulmonary homograft dysfunction after the Ross procedure using decellularized homografts-a multicenter study. J Thorac Cardiovasc Surg  2022;163:1296–305.e3. PubMed

Mylonas  KS, Tasoudis  PT, Pavlopoulos  D, Kanakis  M, Stavridis  GT, Avgerinos  DV. Aortic valve neocuspidization using the Ozaki technique: a meta-analysis of reconstructed patient-level data. Am Heart J  2023;255:1–11. PubMed

Ozaki  S, Kawase  I, Yamashita  H, Uchida  S, Nozawa  Y, Matsuyama  T, et al.  Aortic valve reconstruction using self-developed aortic valve plasty system in aortic valve disease. Interact Cardiovasc Thorac Surg  2011;12:550–553. PubMed

Jaswal  V, Singh Thingnam  SK, Kumar  V, Munirathinam  GK. Surgical valve repair of native pulmonary valve endocarditis using the Ozaki technique. Ann Thorac Surg  2020;110:e509–e511. PubMed

El-Hamamsy  I, Toyoda  N, Itagaki  S, Stelzer  P, Varghese  R, Williams  EE, et al.  Propensity-matched comparison of the Ross procedure and prosthetic aortic valve replacement in adults. J Am Coll Cardiol  2022;79:805–815. PubMed

Gofus  J, Fila  P, Drabkova  S, Zacek  P, Ondrasek  J, Nemec  P, et al.  Ross procedure provides survival benefit over mechanical valve in adults: a propensity-matched nationwide analysis. Eur J Cardiothorac Surg  2022;61:1357–1365. PubMed

David  TE, Ouzounian  M, David  CM, Lafreniere-Roula  M, Manlhiot  C. Late results of the Ross procedure. J Thorac Cardiovasc Surg  2019;157:201–208. PubMed

Unai  S, Ozaki  S, Johnston  DR, Saito  T, Rajeswaran  J, Svensson  LG, et al.  Aortic valve reconstruction with autologous pericardium versus a bioprosthesis: the Ozaki procedure in perspective. J Am Heart Assoc  2023;12:e027391. PubMed PMC

Kanemitsu  S, Tanaka  K, Ishikawa  R, Sakamoto  S, Mizumoto  T. Innovative combined Ozaki and Bentall procedures for aortic root replacement. Multimed Man Cardiothorac Surg  2024;2024. 10.1510/mmcts.2024.038. PubMed DOI

Baird  CW, Chavez  M, Friedman  KG. Pulmonary valve reconstruction using the Ozaki leaflet reconstructive techniques. Ann Thorac Surg  2021;111:e19–e21. PubMed