Modification of the Ross operation to facilitate hemostasis and repair of associated malformations.

: The length of aortic cross clamp time and the difficult control of bleeding sites can represent two major problems during the Ross operation. Dissection of the pulmonary root before aortic cross clamping as well as reconstruction of the right ventricular outflow tract only after completion of the aortic anastomosis and removal of the cross clamp appear to facilitate accurate hemostasis, reducing in addition the time of myocardial ischemia.