Intermediate-term results of Medtronic freestyle valve for right ventricular outflow tract reconstruction in the Ross procedure.

The long-term freedom from complications and reoperation associated with the Ross procedure has made this approach the modern choice for aortic valve replacement (AVR) in children and adults with a long life expectancy. The procedure is ideal for young women with aortic valve disease who plan to bear children, and for those individuals who have contraindications to anticoagulation. Changes in implantation techniques transitioning from subcoronary to total root replacement and performing annular support has led to a reduction in the incidence of pulmonary autograft regurgitation (1). Although the potential exists for an immune response with resultant pulmonary stenosis and possible early explantation of the pulmonary homograft, the overall results of the Ross procedure have been excellent and highly reproducible (2). Despite the modern emphasis which is placed on organ donation, replacement homografts for the donated pulmonary valve remain relatively scarce. This lack of suitable alternatives for right ventricular outflow tract (RVOT) reconstruction has severely limited the wider application of the Ross procedure in many parts of the world. Many alternatives such as valveless conduits, stentless bioprostheses, synthetic valved conduits and autologous repair techniques to homograft replacement during the Ross procedure have been reported during the past few years (3-8). For example, Konertz et al. (9) published the first pulmonary autograft series using Medtronic Freestyle stentless bioprosthesis for RVOT in 1996. Unfortunately, in Turkey the difficulties encountered in obtaining homograft valves has forced surgeons to use the same technique in order to offer the wellknown advantages of the Ross procedure to young patients with aortic valve disease. Address for correspondence: Prof. Dr. Mehmet Salih Bilal, Igrip sok. No: 37-4 Fenerbahce, Kadikoy, Istanbul, Turkey 81040 e-mail: msbilal@doruk.net.tr