Valve-sparing root replacement for pulmonary autograft dissection late after the Ross operation

Aortic valve replacement with the pulmonary autograft (ie, the Ross operation) is generally associated with satisfactory early and late results. Complications, however, can occur, including the tendency of the pulmonary autograft root to dilate with time.1 Whereas neoaortic root dilatation might be observed in as many as one third of patients late after the Ross operation,2 uncertainty still exists as to the rate of progression toward true aneurysmal disease (aortic diameter ≥5 cm).1,2 Furthermore, the actual risk of complications, such as neoaortic rupture or dissection, is also unknown. The yet undefined natural history of root dilatation after the Ross operation, the often satisfactory competence of the pulmonary autograft valve, the scarcity of valid therapeutic alternatives (particularly in the infant and child), and the complexity–risk of reintervention have thus far delayed standardization of therapeutic indications. In particular, timing and technique of reoperation on the aneurysmal neoaortic root are still controversial.1,2Here we present a case of potentially lethal evolution of progressive pulmonary autograft dilatation (ie, neoaortic root dissection) successfully treated with valve-sparing root replacement. The implications in terms of natural history and indications for reintervention are discussed.