The Ross procedure with a bicuspid pulmonary autograft
Bibliographic record
Abstract
BACKGROUND >We illustrate the steps for a Ross procedure in a 24-years old patient who presented with an unicuspid aortic valve with mixed aortic stenosis/aortic regurgitation and who was intraoperatively found to have a bicuspid pulmonary autograft, warranting the need for concurrent repair of the autograft. Without repair of the bicuspid pulmonary autograft, this patient would likely have had cusp prolapse and residual aortic insufficiency, compromising early and late valve function, and ultimately the patient's outcome. METHODS AND RESULTS Although it could be argued to have simply replaced our patient's aortic valve with a standard valve prosthesis, his young age posed a challenge with his longer anticipated life expectancy and higher cumulative risk of prosthesis-related complications. The Ross procedure, unlike standard bioprosthetic or mechanical aortic valve replacement, restores expected survival equivalent to that of age and gender-matched general population. A bicuspid pulmonary valve is considered a rare congenital anomaly with an estimated incidence of 0.1% and may be considered a relative contraindication for the Ross procedure. However, our patient had favourable bicuspid anatomic characteristics with pliable cusps, good commissural orientation, and geometric height of 20 mm, and we applied all the principles of bicuspid aortic valve repair with symmetric commissural implantation, a tailored aortic annuloplasty and achieving an effective height of 10 mm with central cusp plication to ensure a well functioning bicuspid pulmonary autograft. At 1 year follow-up, the patient was completely asymptomatic and ambulating without limitations. Repeat transthoracic echocardiography revealed a normal functioning pulmonary autograft with no aortic insufficiency, normally functioning pulmonary homograft, and preserved left ventricular function and dimensions. We have employed this technique successfully in two patients. To our knowledge, only one previous paper presented a repair of a bicuspid pulmonary autograft valve, but this was for moderate aortic insufficiency noted 5 days after the Ross procedure. CONCLUSION In this report, we present the concomitant repair of a bicuspid pulmonary autograft at the time of the index operation. We aim at drawing on the advantages of the Ross procedure for young patients while restoring the function of the bicuspid pulmonary autograft using common bicuspid aortic valve repair techniques, thus extending the use of the Ross procedure to more patients who would otherwise be considered ineligible.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".