The Ross procedure is a type of heart surgery used to treat diseased aortic valves.
During the procedure, the patient’s diseased aortic valve is replaced with their own pulmonary valve, and a donor valve is used to replace the pulmonary valve.
The Ross procedure is often recommended for younger patients due to its potential for excellent long-term outcomes and the ability to avoid repeated surgeries.
Cardiac surgeons at WashU Medicine
Heart surgeons at WashU Medicine see patients at Barnes-Jewish Hospital, one of the top hospitals in the nation for heart and vascular care, as well as convenient locations across the region.
What is the Ross procedure?
The Ross procedure is a specialized heart surgery where the patient’s diseased aortic valve is replaced with their own pulmonary valve (called an autograft).
A donor valve (called a homograft) or bioprosthetic valve is then used to replace the displaced pulmonary valve.
This surgical technique is primarily used to treat conditions affecting the aortic valve, such as aortic stenosis or aortic regurgitation.
The Ross procedure is particularly beneficial for younger patients as it utilizes living tissue that can grow and adapt over time.
Who might need the Ross procedure
The Ross procedure is indicated for patients with various aortic valve conditions, including:
Aortic valve disease
- Aortic stenosis: Narrowing of the aortic valve, causing restricted blood flow.
- Aortic regurgitation: Leakage of the aortic valve, leading to blood flow back into the left ventricle.
Related: WashU Medicine Aortic Center>>
Congenital heart defects
- Bicuspid aortic valve: A congenital defect where the aortic valve has only two cusps instead of the normal three, leading to early valve deterioration.
Other conditions
- Valve endocarditis: Infection of the aortic valve causing damage.
- Degenerative valve diseases: Conditions where the valve tissue degenerates over time.
Get a second opinion
Our Heart Second Opinion Program was created for patients diagnosed with any heart condition, or for patients who have been told they need a heart-related surgical procedure.
The Ross procedure surgical process
The Ross procedure involves several detailed steps performed under general anesthesia:
Preoperative preparation
- Anesthesia: The patient is put under general anesthesia for the duration of the surgery.
- Incision: The surgeon makes an incision in the chest to access the heart.
Surgical steps
- Removal of diseased aortic valve: The surgeon carefully removes the diseased aortic valve.
- Pulmonary valve transfer: The surgeon harvests the pulmonary valve (autograft) and places it in the aortic position.
- Pulmonary valve replacement: The empty pulmonary valve position is filled using a donor valve (homograft) or a bioprosthetic valve.
- Closure: The incision is closed, and the patient is moved to the recovery area.
Postoperative care
- Monitoring: Continuous monitoring in the intensive care unit (ICU) to manage recovery and detect any complications.
- Medications: Administration of pain medications, antibiotics, and anticoagulants to aid recovery and prevent infections.
Benefits of the Ross procedure
The Ross procedure offers several advantages, especially for younger patients:
Long-term outcomes
- Valve growth: The autograft can grow with the patient, reducing the need for future valve replacements.
- Durability: The living pulmonary valve can last longer than mechanical valves or other prosthetic options.
Reduced risk of complications
- Hemodynamic performance: The autograft mimics the native aortic valve’s performance, ensuring efficient blood flow.
- Lower thromboembolism risk: Reduced risk of clot formation compared to mechanical valves.
Improved quality of life
- No lifelong anticoagulation: Unlike mechanical valves, the Ross procedure can eliminate the need for lifelong blood-thinning medications, which can improve lifestyle and reduce bleeding risks.
Heart & Vascular Center
Achieving excellence through patient care, research and education is the mission of the Washington University and Barnes-Jewish Heart and Vascular Center.
Our team of physicians and nurses are committed to improving heart and vascular health through their expertise, collaboration and compassion.
Risks of the Ross procedure
While the Ross procedure has many benefits, it also carries certain risks:
Surgical risks
- Bleeding: Risk of bleeding during or after surgery.
- Infection: Possibility of infection at the surgical site or within the heart.
Postoperative complications
- Valve dysfunction: Potential for the transplanted valves to fail over time, requiring additional surgeries.
- Arrhythmias: Irregular heartbeats that may need medical management.
General risks
- Reaction to anesthesia: Possible adverse reactions to anesthesia during surgery.
- Pulmonary homograft issues: Potential complications related to the donor valve, such as rejection or degeneration.
Recovery after the Ross procedure
Recovery from the Ross procedure involves a combination of hospital care and follow-up visits:
Initial recovery
- Hospital stay: Typically 5–7 days in the hospital, including ICU monitoring.
- Pain management: Use of pain relief medications to manage postoperative pain.
Long-term recovery
- Activity restrictions: Avoiding strenuous activities for several weeks to allow the chest and heart to heal.
- Regular follow-up: Regular check-ups with a cardiologist to monitor heart function and valve performance.
- Healthy lifestyle: Adopting a heart-healthy diet and regular exercise, as recommended by healthcare providers.
Life after the Ross procedure
Life after the Ross procedure involves ongoing care and lifestyle adjustments:
Heart health monitoring
- Regular exams: Routine medical exams and echocardiograms to ensure valve function and heart health.
- Medication management: Taking prescribed medications as directed by your healthcare providers.
Lifestyle adjustments
- Diet and exercise: Following a heart-healthy diet and engaging in regular physical activities.
- Awareness of symptoms: Being vigilant about any new or worsening symptoms and seeking medical attention promptly.
If you have been diagnosed with a condition that may require the Ross procedure, consult with a cardiac surgeon to explore this option.
With appropriate preparation, surgery, and post-operative care, the Ross procedure can significantly enhance your quality of life and provide durable valve function.
