Ross Procedure for Aortic Valve Replacement
The Ross procedure is a type of open-heart surgery that uses the patient's own pulmonary heart valve to replace the diseased aortic valve with a living. The pulmonary valve is then replaced with a donor pulmonary homograft that has been decellularized and cryopreserved. Compared to a mechanical/synthetic heart valve replacement, the Ross procedure can provide better durability, improved hemodynamics (blood flow), and reduced risk of valve deterioration without the need for blood thinners or anticoagulants.
At the Comprehensive Aortic Center at UHealth, our team of experienced aortic surgeons perform some of the most intricate heart operations, including the Ross procedure. UHealth's experienced cardiovascular specialists evaluate each patient to determine if the Ross procedure or another type of aortic valve surgery is the best option.
What Is the Ross Procedure?
The Ross procedure, also called a pulmonary autograft procedure, is an advanced type of aortic valve replacement available to young adults with aortic valve disease.
During the procedure:
- Your surgeon removes the diseased aortic valve.
- Your healthy pulmonary valve is "transplanted" into the aortic position. This is called a pulmonary autograft.
- A donor human pulmonary valve, called a pulmonary homograft is placed in the pulmonary valve position.
Who Is a Candidate for the Ross Procedure?
The Ross procedure can be considered for children, young adults and other carefully selected patients who need aortic valve replacement. It is well suited for younger patients because living heart tissue adapts and grows with the patient. Typically, a patient may be considered a candidate for the Ross procedure if they are under the age of 60.
UHealth's cardiovascular team will consider your age, overall health, anatomy, type of aortic valve disease and other factors when recommending treatment.
The Ross procedure may be an option if you have:
- Severe aortic stenosis, which occurs when the aortic valve becomes narrowed and restricts blood flow
- Severe aortic regurgitation, which occurs when the valve does not close properly and allows blood to leak backward into the heart
- A bicuspid aortic valve or other congenital aortic valve disease
- Any need for aortic valve replacement at a young age
What Are the Benefits of the Ross Procedure?
For appropriately selected patients, the Ross procedure offers several potential advantages. Your surgeon will discuss the potential benefits in the context of your individual condition.
Potential advantages can include:
- A living pulmonic valve functions similarly to a natural aortic valve
- Excellent blood flow and resistance to infection
- Avoidance of lifelong anticoagulation medication often needed for patients following mechanical aortic valve replacement
- Potential for growth
What Are the Risks and Disadvantages of the Ross Procedure?
The Ross procedure is a complex heart operation and is not appropriate for everyone. Therefore, it has to be performed at high-volume centers with the expertise required to achieve a risk equal to, or lower than conventional or minimally invasive aortic valve replacement.
Potential risks and complications depend on the individual patient and should be discussed with our experienced Ross surgeons. The most recent series of Ross procedures have shown excellent durability, similar to that of mechanical valves and far superior to bioprosthetic valves, with a reintervention rate of 1% at 12 years.
Your UHealth care team will weigh these considerations against the potential benefits of the Ross procedure and alternative treatments.
Ross Procedure vs. Mechanical or Tissue Valve Replacement
Choosing an aortic valve replacement involves more than deciding which operation to have. The best option depends on factors including your age, anatomy, type of valve disease, overall health, lifestyle and personal treatment goals. The goal is to select the valve strategy that offers you the best balance of durability, quality of life and long-term risk, as well as preferred access; whether conventional or minimally invasive
- A mechanical valve can be extremely durable but typically requires lifelong anticoagulation.
- A tissue valve generally does not require lifelong anticoagulation but deteriorates over time, requiring a reoperation
- A living valve has several advantages such as better hemodynamic performance, resistance to infection, potential for growth in children, and excellent durability in carefully selected patients.
How Long Does the Ross Procedure Take?
The length of Ross procedure surgery varies based on the patient's anatomy, valve disease, whether additional aortic or cardiac procedures are required and other factors. Our surgical team can provide a more individualized estimate after reviewing your imaging and surgical plan.
What Is Recovery Like After the Ross Procedure?
Recovery after the Ross procedure is no different from other aortic valve replacement techniques.
Patients initially recover in the hospital, where our cardiovascular team monitors heart function and the newly positioned valves. Recovery then continues at home as patients gradually return to normal activities.
Your care team will provide individualized instructions about physical activity, incision care, medications, cardiac rehabilitation and when you can return to work, exercise and other activities.
Long-term follow-up is important after a Ross procedure, with very carefully blood pressure control for the first 6 months. Your cardiology and surgical teams will monitor both the pulmonary autograft in the aortic position and the replacement pulmonary valve.
How Long Does a Ross Procedure Last?
The Ross procedure is intended to provide long-term aortic valve function, but individual outcomes vary.
Durability depends on multiple factors, including the patient's anatomy, age, underlying heart condition and surgical technique. Because both the pulmonary autograft and the replacement pulmonary valve can change over time, patients need lifelong cardiovascular monitoring.
Your surgeon can discuss expected outcomes based on your individual condition and the latest clinical evidence.
Patient Testimonial
Talk to a Ross Procedure Specialist
If you have been told you need aortic valve replacement or want a second opinion about aortic valve surgery, the specialists at UHealth's Comprehensive Aortic Center can evaluate your condition and discuss whether the Ross procedure may be an option.
Call (305) 4-AORTIC or Request an Appointment.
Meet Our Leaders in Aortic Disease and Aortic Surgery
UHealth’s Comprehensive Aortic Center is led by internationally trained surgeons specializing in diagnosing and treating complex aortic diseases. Together, they collaborate with specialists across UHealth’s departments of cardiology, imaging, and critical care to deliver coordinated and advanced surgical care.
Why Choose UHealth for the Ross Procedure?
At the Comprehensive Aortic Center at UHealth, cardiovascular specialists work together to evaluate complex aortic valve and aortic disease and determine the most appropriate treatment for each patient. The Ross procedure requires specialized expertise in complex aortic valve surgery and careful patient selection.
Your evaluation considers not only whether your aortic valve needs to be replaced, but also your anatomy, overall cardiovascular health, lifestyle and long-term treatment goals. When appropriate, your team can discuss the Ross procedure alongside other surgical and minimally invasive options, so you understand the potential benefits and risks of each approach.
Our program is ranked by US News & World Report as one of the top 50 hospitals in the country in Cardiology, Heart & Vascular Surgery.
Schedule an Appointment
If you or a loved one has been diagnosed with an aortic aneurysm, aortic dissection, or another aortic condition, our team is ready to help.