Ross Procedure After Valve-Sparing Root Replacement With Marfan Syndrome

BACKGROUND: The Ross procedure is one of the optimal surgical options for aortic valve pathologies in relatively young patients. However, its application in patients with Marfan syndrome (MFS) is not only debatable but may even be considered a contraindication. CASE SUMMARY: A 31-year-old woman with MFS had undergone valve-sparing root replacement 2.5 years earlier and now presented for treatment of severe aortic insufficiency (AI). A Ross procedure with stabilization of the aortic root was performed. Two years after the procedure, mild AI was observed; however, the patient was asymptomatic, and left ventricular function was preserved. DISCUSSION: Although the latest expert consensus concludes that Ross procedures should be avoided in patients with MFS, it may be premature to rule out the procedure solely because of the potential for autograft dilation. TAKE-HOME MESSAGES: For patients with MFS, while the Ross procedure may not necessarily be considered a contraindication, careful consideration of its indication is necessary. If surgery is performed, modifications and meticulous follow-up are required.