Reply: Wrapped pulmonary autograft or homograft: Still the way to go!

The author reported no conflicts of interest.The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. The author reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. We would like to thank Drs Gerosa and Pradegan from Padova, Italy, for their thoughtful letter to the editor in response to our recent manuscript in the Journal1Starnes V.A. Elsayed R.S. Cohen R.G. Olds A.P. Bojko M.M. Mack W.J. et al.Long-term outcomes with the pulmonary autograft inclusion technique in adults with bicuspid aortic valves undergoing the Ross procedure.J Thorac Cardiovasc Surg. 2023; 165: 43-52.e2Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar describing our experience with the Ross procedure performed using a pulmonary autograft inclusion technique in patients with bicuspid aortic valves. Between 1992 and 2019, 129 patients with bicuspid aortic valves underwent the Ross procedure by a single surgeon, with or without the pulmonary autograft inclusion technique. In our series, the pulmonary autograft was “wrapped” by encasement in a vascular graft. Over a median follow-up of 10.3 years, we found that mortality did not differ between groups; however, we did find that the need for autograft reintervention was lower in those with “wrapped” pulmonary autografts (P < .035). Although we state that the pulmonary inclusion technique was adopted in 2001, the authors have misinterpreted our manuscript, as we simply mean the technique was adopted at our institution in 2001. Gerosa and Pradegan importantly point us to a series of manuscripts from 1994 by their group that were inadvertently not included in our report,2Gerosa G. Ross D.N. Brucke P.E. Dziatkowiak A. Mohammad S. Norman D. et al.Aortic valve replacement with pulmonary homografts. Early experience.J Thorac Cardiovasc Surg. 1994; 107 (discussion 436-7): 424-436Abstract Full Text PDF PubMed Scopus (37) Google Scholar, 3Pacifico A.D. Kirklin J.K. McGiffin D.C. Matter G.J. Nanda N.C. Diethelm A.G. The Ross operation—early echocardiographic comparison of different operative techniques.J Heart Valve Dis. 1994; 3: 365-370PubMed Google Scholar, 4Pradegan N. Castaldi B. Azzolina D. Stellin G. Vida V.L. Long-term fate of the neoaortic root after neonatal Ross operation: a case series.World J Pediatr Congenit Heart Surg. 2019; 10: 364-366Crossref PubMed Scopus (5) Google Scholar, 5Gerosa G. Pradegan N. Wrapped Ross: oldies, but goldies.J Thorac Cardiovasc Surg. 2023; 166: e3Abstract Full Text Full Text PDF Scopus (1) Google Scholar which indeed describe a similar technique whereby a pulmonary homograft was placed in a short cylinder and used to replace the aortic root. The results in these reports and summarized in their Letter to the Editor are impressive. We apologize to the Editor and readers, as we did not need to imply that we were the first to adopt the technique of placing an autograft or homograft inside an encased tube in hopes of preventing subsequent auto- or homograft dilatation. Regardless of this omission, we agree with Gerosa and Preadgan that the encasement of the pulmonary autograft in a vascular conduit is a valuable modification to the Ross technique, as it creates a somewhat technically easier operation, which is also more teachable, while also preventing autograft dilatation. Wrapped Ross: Oldies, but goldies…The Journal of Thoracic and Cardiovascular SurgeryVol. 166Issue 1PreviewWe read with great interest the article by Starnes and colleagues1 that showed excellent 10-year results of the wrapped vs unwrapped Ross procedure in adults with a bicuspid aortic valve. We also believe that using the inclusion technique with an artificial external vascular conduit can stabilize the pulmonary autograft to prevent late dilation and pulmonary autograft reintervention, and this has become part of our current Ross policy in young adults scheduled for this operation. Full-Text PDF