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Competing Interests: Dr Szeto is an investigator, advisory board member, and speaker for Edwards, Medtronic, Artivion, Terumo Aortic, and Abbott. Dr Grimm is a consultant and received a paid honorarium from Terumo as well as a paid honorarium from Cook. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Background: Concurrent aortic and mitral valve repair presents specific technical challenges to surgeons. Here we evaluate the outcomes of patients undergoing combined valve-sparing aortic root reimplantation and mitral valve repair., Methods: We performed a retrospective review of patients at our center between 2006 and 2021 who underwent concomitant valve-sparing aortic root replacement and mitral valve repair. Patient characteristics, including preoperative and postoperative valve function, and operative outcomes were analyzed., Results: Between 2006 and 2021, 14 patients underwent valve-sparing aortic root replacement with concurrent mitral valve repair. Mean age of the patients at operation was 39 ± 20 years. Almost half of the patients (6/14) had Marfan disease. The primary indication for operation in all patients was aortic root dilation. Preoperatively, all patients (14/14) had moderate to severe mitral regurgitation, and half (7/14) had moderate to severe aortic regurgitation. Patients underwent mitral annuloplasty alone (9/14) or had concurrent leaflet repair (5/14). The median length of intubation was 0 day (interquartile range, 0-1 day), and median length of stay was 7 days (interquartile range, 6-10 days). At average follow-up of 6.8 ± 4.2 years, 13 of 14 patients had none to trace aortic and mitral regurgitation. One patient required reoperation for late recurrence of aortic and mitral regurgitation. There was no early or late cardiovascular mortality., Conclusions: Mitral valve repair can be performed safely with excellent short-term and long-term results in selected patients undergoing valve-sparing aortic root reimplantation. For durable bivalvular repair to be achieved, specific technical considerations should be adhered to., (© 2023 Published by Elsevier Inc. on behalf of The Society of Thoracic Surgeons.)

Background: There has been renewed interest in the Ross procedure in young patients with aortic valve disease. We describe the details and results of a systematic strategy to launch a new Ross program., Methods: Our department developed a multidisciplinary educational program that involved all practitioners involved in the care of potential Ross patients. A core group of surgeons underwent extensive hands-on technical preparation. Selection of patients was reviewed by a multidisciplinary team. Patient characteristics, operative details, and postoperative outcomes were analyzed., Results: Between March 2021 and March 2022, 22 consecutive patients underwent Ross procedure at our institution. The mean age of the patients at time of operation was 40.4 ± 10.2 years, and most patients had no medical comorbidities (12/22). The most common indication for operation was aortic stenosis (13/22), followed by mixed aortic stenosis and aortic insufficiency (7/22). There were no deaths. Postoperatively, no patient required blood transfusion or reexploration for hemorrhage. All patients were discharged home on mean hospital day 5.9 ± 1.1. On predischarge echocardiography, there was a significant reduction in mean aortic gradients preoperatively to postoperatively (49 ± 20 mm Hg vs 4 ± 1 mm Hg; P < .01) without aortic insufficiency or a change in left or right ventricular function., Conclusions: We demonstrate that with multidisciplinary education and extensive hands-on surgical preparation under proctored supervision, a Ross program can be initiated safely with excellent short-term results and perioperative risk that mimics that of conventional surgical aortic valve replacement., (© 2022 Published by Elsevier Inc. on behalf of The Society of Thoracic Surgeons.)