I. Didactic Sessions (Heads-Up) Each with protected discussion time immediately following. Questions
Survival and Quality of Life: What do we know for certain about survival and quality of life following the Ross procedure compared to other AVR options?
Indications: Can we identify the threshold of LV functional reversibility/irreversibility with aortic valve disease in the context of timely AVR? What should the next Guidelines look like and how will they differ from the current Guidelines? Who are ideal candidates for the Ross procedure and what is the upper age limit? Should a bicuspid aortic valve (BAV) with aortic regurgitation, annular dilatation and/or an ascending aortic aneurysm be a contraindication for a Ross procedure?
Availability: Why is the Ross procedure offered to so few candidates and what is the impact of “risk-aversion” on the part of the surgeon? What can be done to make the Ross procedure more widely available? How should bias toward the Ross procedure be countered? How should the Ross procedure be taught to surgeons?
Basic Science: What is known about the embryogenesis of the various BAV phenotypes? What is known about the various BAV phenotypes and the prevalence of a concomitant aortopathy? What impact, if any, should various BAV phenotypes and aortopathy have on the suitability of the Ross procedure? Does the matrix abnormality of the aorta accompanying the BAV also affect the pulmonary root?
Technique: Which surgical techniques for the Ross procedure have proven durability? Are there different ways to perform a structurally and functionally long-lasting pulmonary autograft? When should the ascending aorta be replaced? Is an aortoplasty ever appropriate?
Physiology: How do the hemodynamics, biomechanics and flow characteristics of a successful pulmonary autograft compare with other AVR options?
Valve-Sparing: What is the state-of-the-art and science of the various valve-sparing procedures and their application to a failing pulmonary autograft? Is a Ross procedure reasonable even with a higher risk of later autograft failure (e.g., pre-operative aortic regurgitation/annular dilatation) if the autograft could be salvaged with a low-risk valve-sparing procedure? Can a valve-sparing procedure for a failing pulmonary autograft restore expected survival?
Aortic Valve Repair: Should an aortic valve repair be offered as the initial operation instead of a Ross procedure if feasible? Is the Ross procedure a logical backup to an aortic valve repair which is either not possible or has failed? What do we know about long- term survival with aortic valve repair compared to various replacement options?
The Living Valve: What evidence do we have that a living valve can impact long-term survival-- specifically the pulmonary autograft, mitral valve repair, aortic valve repair and aortic valve-sparing procedures? If a living valve confers a survival advantage over prosthetic valves in a given patient population, how should this influence the conduct of informed consent and shared decision-making between physician and patient?
Faculty
Agenda
