Clinical vignette

A fifty-four-year-old man with a history of hypertension, hyperlipidemia and cigarette smoking presented to hospital following a syncopal episode. He reported worsening shortness of breath and dyspnea on exertion. A comprehensive workup revealed severe bicuspid aortic stenosis [mean gradient: 44 mmHg and aortic valve (AV) area: 0.62 cm²], preserved left ventricular function and nonsignificant coronary artery disease. Computerized tomography scan showed a 42 mm ascending aorta. Given his age, overall health, cardiac function, and anticipated life expectancy >15 years, a Ross procedure was planned. When performed in centers of expertise, the Ross procedure provides optimal long-term survival, hemodynamics and quality of life (1). However, the safety and long-term durability of the operation depend on various technical factors, which we aim to detail in this video.