Ross Procedure

Ross Procedure

Ross Procedure

With this operation the aortic valve is replaced with the patient’s own pulmonary valve, which is in turn replaced with a human pulmonary valve (allograft or homograft). The advantage of this procedure is that the aortic valve replacement is the patient’s own tissue, which is viable, and has the potential to last 40 years plus ie a lifetime for many patients.

The major advantage of the Ross procedure, is that the patient has a durable tissue valve substitute and does not need to take warfarin (blood-thinning medication) at all, with its attendant complications and problems with monitoring. Also, the patient’s own pulmonary valve, as an aortic valve substitute, functions in a better haemodynamic way than the alterative mechanical prosthesis, with lower residual trans-valvular pressure gradients across the valve. There is also no ticking noise, as would accompany a mechanical valve replacement. It is a longer and more complicated procedure than a mechanical or xenograft valve replacement, although this does not appear to increase the risk at all, providing an experienced operator is performing the procedure. Perhaps the only two disadvantages are that the durability is not quite as good as with a mechanical valve ie one can expect slightly more valve failures leading to re-operation compared to mechanical valve recipients. Estimated durability is 85% at 20 years (compared with 90% with a mechanical valve). Earlier concerns that the pulmonary valve allograft replacement could be a drawback to the procedure have proven unfounded, with an extremely low incidence of late problems (including re-operations) with the pulmonary valve substitute. This operation is most suited to younger patients (less than 60 years of age). The risk does increase with older patients, those with co-morbidities (eg lung and kidney disease) and If other cardiac procedures are required simultaneously (eg coronary artery bypass surgery).

Applicable Age Range: 15-60 years

Advantages:

  • Warfarin not required at any stage: excellent quality of life without blood tests or anticoagulation related complications, absence of thrombo-embolic complications, zero incidence of anti-coagulant related haemorrhage
  • Best Durability of any tissue (non-mechanical valve), 85% at 20 years durability
  • Possible to fall pregnant after the operation

Disadvantages:

  • More complex operation (five hours vs three hours for a mechanical valve)
  • Should be performed by an experienced operator
  • Durability not quite as good as mechanical valve
  • Follow-up of both Aortic and Pulmonary valves required, although pulmonary valve re-operation rate extremely low

Contra-indications

  • Bicuspid pulmonary valve(echo)
  • Other connective tissue disease (eg Rheumatoid arthritis/ SLE)
  • Triple vessel Coronary Artery Disease/ Mitral valve disease

Surgical Risks
In patients under the age of 70 years, operative risk is 1% regardless of procedure. The major post-operative risk is that of cerbero-vascular accident (CVA – Stroke) which occurs in an additional 1%. Other complications include necessity for permanent pacemaker (1%), sternal wound infection (0.5%).

This document is intended for informational purposes and is not intended to be a substitute for the advice of a doctor or healthcare professional or a recommendation for any particular treatment plan. Like any printed material, it may become out of date over time. It is important that you rely on the advice of a doctor or a healthcare professional for your specific condition.