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Fig. 6.21e. The distal anastomosis of the pulmonary autograft is performed. Courtesy of Dr. Jeff Milliken, Harbor-UCLA.

Fig. 6.21 f. An aortic homograft is prepared for insertion into patient's pulmonary position. Courtesy of Dr. Jeff Milliken, Harbor-UCLA.

Fig. 6.21e. The distal anastomosis of the pulmonary autograft is performed. Courtesy of Dr. Jeff Milliken, Harbor-UCLA.

nique include protection from suture line bleeding, but a disadvantage is that if bleeding does occur between the wrap and the allograft, distortion of the valve leaflets or coronary ostia may occur.

The pulmonary autograft (Ross) procedure for aortic valve replacement involves replacing the patient's aortic valve and root with a pulmonary autograft, then using an allograft in the pulmonary position (Fig. 6.21a-f). The rationale for using such a complex procedure is the increased durability of the pulmonary autograft compared to an allograft in the aortic position. Additionally, the allograft has increased durability in the pulmonary position compared to the aortic position. The procedure has been controversial because of its complexity for what is usually a straightforward operation, and probably should only be performed in experienced centers.

Suggested Reading

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