Valve-sparing aortic root replacement after previous Ross procedure: two different surgical strategies.

A 22-year-old male born with congenital aortic valve (AV) stenosis underwent an open aortic valvuloplasty at 3-week of age, followed by Ross procedure at age fifteen. Comorbidities include obesity, and heterozygous prothrombin gene mutation. He developed progressive autograft dilation and severe right ventricular outflow tract (RVOT) obstruction secondary to calcified pulmonary homograft. Preoperative evaluation showed severely dilated autograft sinuses (5 cm), trivial neo-AV regurgitation, and calcified pulmonary homograft. We advised repeat operation with valve-sparing aortic root replacement and re-replacement of the pulmonary homograft.