Ex Vivo Biomechanical Analysis of the Ross Procedure Using the Modified Inclusion Technique in a 3D-Printed Left Heart Simulator

ABSTRACT Objective The inclusion technique was developed to reinforce the pulmonary autograft to prevent dilation after the Ross procedure. Anti-commissural plication (ACP), a modification technique, can reduce graft size and create neo-sinuses. The objective was to evaluate pulmonary valve biomechanics using the inclusion technique in the Ross procedure with and without ACP. Methods Seven porcine and five human pulmonary autografts were harvested from hearts obtained from a meat abattoir and from heart transplant recipients and donors, respectively. Five additional porcine autografts without reinforcement were used as controls. The Ross procedure was performed using the inclusion technique with a straight Dacron graft. The same specimens were tested both with and without ACP. Hemodynamic data, echocardiography, and high-speed videography were collected via the ex vivo heart simulator. Results Porcine autograft regurgitation was significantly lower after the use of inclusion technique compared to controls (p Conclusions The Ross procedure using the inclusion technique demonstrated excellent hemodynamic results. The ACP technique was associated with more favorable leaflet biomechanics. In vivo validation should be performed to allow direct translation to clinical practice.