Reinforcement of the Pulmonary Autograft with a Prosthetic Graft to Prevent Dilatation After the Ross Procedure Thierry Carrel, MD, Florian Schönhoff,

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Reinforcement of the Pulmonary Autograft with a Prosthetic Graft to Prevent Dilatation After the Ross Procedure Thierry Carrel, MD, Florian Schönhoff, MD, Thierry Aymard, MD, Alexander Kadner, MD Operative Techniques in Thoracic and Cardiovascular Surgery Volume 17, Issue 1, Pages 41-43 (March 2012) DOI: 10.1053/j.optechstcvs.2011.02.001 Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 1 The autograft is inserted into the prosthesis and fixed with a running suture of 4-0 prolene at the proximal (A) and distal (C) endings. Diameter of the Valsalva prosthesis is chosen 2 to 4 mm larger than the diameter of the pulmonary autograft. The proximal end (collar) of the prosthesis is trimmed, leaving only a rim of 1 to 2 mm below the sinus enlargement. 1 = native aortic root (to be excised); 2 = pulmonary autograft; V = Valsalva reinforced autograft. (Color version of figure is available online at http://www.optechtcs.com.) Operative Techniques in Thoracic and Cardiovascular Surgery 2012 17, 41-43DOI: (10.1053/j.optechstcvs.2011.02.001) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 2 A standard technique of complete root replacement with running sutures is used for the implantation of the autograft. The coronary ostia are implanted with a running suture after using an aortic punch for performing button holes (arrow) into the Valsalva graft (V) and the pulmonary autograft. 3 = pulmonary homograft; V + 2 = Valsalva reinforced autograft with the 2 coronary buttons. (Color version of figure is available online at http://www.optechtcs.com.) Operative Techniques in Thoracic and Cardiovascular Surgery 2012 17, 41-43DOI: (10.1053/j.optechstcvs.2011.02.001) Copyright © 2012 Elsevier Inc. Terms and Conditions