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Ross Procedure

The Ross Procedure is a pulmonary autograft procedure for patients with aortic valve disease. It is named for Dr. Donald Ross, a British surgeon who developed the procedure in 1967.

Unlike other valve replacement procedures that use a mechanical valve or a tissue valve taken from an animal (most commonly a pig), the Ross procedure replaces a patient's aortic valve with their own pulmonary valve. A donor tissue valve is then used to replace the patient's pulmonary valve. Surgeons prefer the pulmonary valve because it is the patient's own tissue, and is identical in strength, size and shape to the aortic valve.

Which patients can benefit from the Ross procedure?

The Ross procedure was designed for people with aortic valve disease (stenosis, regurgitation, or both). If left untreated, aortic valve disease can lead to angina (chest pain), an enlarged heart, shortness of breath and heart failure.

The procedure is best for patients who have a good life expectancy and no other major illnesses. While most patients are male, the Ross procedure is ideal for women of childbearing age because it eliminates the need for anticoagulant therapy (Coumadin, for example), which can lead to birth defects.

Is the Ross procedure better than other aortic valve replacement procedures?

Generally, the answer is yes, for the following reasons:

  • No blood thinners are needed after the operation. When the aortic valve is replaced by a mechanical valve, the patient must then take anticoagulant medication for the rest of their life. To avoid excess bleeding or hemorrhage, patients must be monitored with a blood test every 3-4 weeks.
  • The replacement valve is not damaged by calcification, which can be a problem with animal valves. In general, the younger the patient, the less durable the animal valve.
  • Using the patient's own pulmonary valve as a replacement ensures it is the correct size.
  • No artificial materials are used in the new aortic valve, which prevents rejection. Also, since the new valve is created from the patient's own tissue, the valve is already alive and healthy, and is not frozen or treated with chemicals.

Other advantages of the Ross procedure:

  • No sudden valve failures or death from aortic valve malfunction.
  • Valve reconstruction is accomplished using natural materials.
  • Compared to mechanical valves, the autograft is noiseless.
  • Patients can exercise and play sports after the procedure.
  • The procedure virtually eliminates blood clots or stroke.
  • The valve lasts longer.
  • Low reoperation rate (15 percent after 20 years).

Success Rate

More than 97 percent. More than 80 percent of patients receiving the Ross procedure are still alive 20 years later; less than 15 percent need additional valve procedures; and 75 percent remain free of any other cardiac event, including endocarditis, degeneration of the valve, reoperation and death.

Recovery Time

Most patients leave the hospital after 3-4 days, and return to work and daily activities – including regular exercise – within 4-6 weeks. Follow-up care usually includes an echocardiogram (an ultrasound of the heart) twice a year.