The aortic root has a sophisticated architecture that results in hemodynamic performance and longevity beyond any prosthetic replacement.2 The seminal step by Mr Ross to enlist the aortic valve's living twin as its replacement has produced outstanding results at experienced centers.3,4 Several considerations have hampered the widespread adoption of the Ross procedure, one of which has been autograft dilatation, with consequent valvular failure.4,5 A focused effort to understand the clinical drivers of this process has reduced its incidence and highlighted its independent predictors.
