Ross procedure

The Ross procedure is the use of a pulmonary homograft for surgical aortic valve replacement. It was developed in 1967 by a British surgeon, Dr. Donald Ross, and has undergone several refinements since. It can be used to treat a broad array of aortic valve pathologies, often aortic stenosis. 

Procedure

This involves the surgical replacement of the aortic valve and root with the patient’s native pulmonary valve and proximal pulmonary artery (homograft). Then the pulmonary valve and right ventricular outflow tract (RVOT) is replaced by a cadaveric pulmonary valve (allograft). Alternatively, the disease aortic valve can be

Advantages 

•      1. No need for anticoagulation.

•      2. The valve grows as the patient grows in children.

•      3. Favorable hemodynamics.

•      4. No prosthetic material present in the valve.

Disadvantages​

•      Converting a single valve problem into a two valve problem.

Complications

Reported complications include

• aortic insufficiency
• right ventricular outlet obstruction and insufficiency
• aortic autograft dilatation
• pulmonary allograft stenosis.
• aneurysms

Contraindications

Include multivessel coronary artery disease as well as multiple pathology in which a second valve replacement device is required. Extremes of age and severely depressed left ventricular function also contradict application of the pulmonary autograft.

Treatment and prognosis

Cardiac MRI is useful for evaluating post-Ross procedure patients.The main limitation of the procedure is the need for reoperation in some patients.