Ross Procedure

What is a Ross Procedure?

The Ross procedure is a specialized form of open aortic valve surgery, most often offered to children, young adults, and selected middle-aged patients who require durable, long-lasting valve function.

How Does It Work?

In the Ross procedure, the patient’s own pulmonary valve is used to replace the diseased aortic valve. The pulmonary valve is then replaced with a donor valve (pulmonary homograft) or with a porcine valve (pulmonary xenograft). In some patients, a short part of the ascending aorta is replaced with a vascular prosthesis.

Because the new aortic valve is living tissue from the patient’s own body, it can function naturally, adapt to physical activity, and grow over time, especially in children. The donor or porcine valve placed in the pulmonary position works under lower pressure and typically lasts many years.

This two valve operation is technically complex and should be performed in experienced centers by surgeons familiar with the Ross technique.

When Is the Ross Procedure Used?

The Ross procedure may be considered in patients who:

  • Have severe aortic valve disease ( usually stenosis, regurgitation, or both)

  • Are young or physically active and want to avoid lifelong anticoagulation

  • Have congenital aortic valve abnormalities, such as a bicuspid valve

  • Are children or adolescents whose valves must grow with them

It is not suitable for every patient. Careful evaluation of the aorta, pulmonary valve, and overall heart function is essential before recommending this operation.

Benefits and Limitations

Benefits

  • Excellent blood flow and natural valve function

  • No need for lifelong blood thinning medication in most patients

  • Ability to tolerate exercise and physical activity well

  • Growth potential in children and adolescents

  • Long term survival comparable to the general population in selected patients

Limitations

  • More complex surgery involving two valves

  • Longer operating time compared with standard valve replacement

  • Risk of future procedures involving either valve

  • Requires a highly experienced surgical team

What to Expect During the Procedure

The operation is performed under general anesthesia and typically lasts several hours. The surgeon opens the chest through the breastbone, connects the patient to a heart–lung machine, and carefully replaces the aortic valve using the patient’s pulmonary valve. A donor or a porcine valve is then placed in the pulmonary position. In some patients a short part of the ascending aorta is replaced with a vascular prosthesis.

After surgery, patients are transferred to the intensive care unit for close monitoring, followed by a stay in the cardiac ward as recovery progresses.

Possible Risks and Complications

As with any open heart surgery, the Ross procedure carries risks, which may include:

  • Bleeding or infection

  • Heart rhythm disturbances

  • Aortic and/or pulmonary valve dysfunction over time

  • Risk of future procedures involving either valve

  • Rare but serious complications such as stroke or heart failure

In experienced centers, outcomes are generally very good, and serious complications are uncommon.

Recovery and Follow Up

Hospital stay: Typically 1-2 weeks, with intensive monitoring in the early postoperative period

Rehabilitation: Gradual return to normal activity over weeks to months, supported by cardiac rehabilitation programs

Imaging: Lifelong surveillance with echocardiography, CT, or MRI

Medication: Blood pressure-lowering medications are essential; anti-inflammatory drugs in the first 3 to 6 months postoperatively are recommended

Lifestyle adjustments: Patients are advised to avoid heavy lifting and high-intensity sports for at least four weeks after the surgery. Instead, they should engage in moderate aerobic activities such as walking or jogging.