The Ross Procedure

UT Southwestern Medical Center’s specialized cardiothoracic surgeons perform the Ross procedure on certain patients who would like an alternative to conventional valvular replacement, such as a mechanical valve or bioprosthetic valve.

This advanced procedure – also called a pulmonary autograft – gives patients with aortic regurgitation and aortic stenosis a proven treatment alternative.

What Is the Ross Procedure?

The Ross procedure is a surgical variation of an aortic valve replacement. It involves replacing the damaged aortic valve with the patient’s own pulmonary valve, which is then replaced with a donor valve.

Using a patient’s own valve as a replacement lessens damage to red blood cells and minimizes clotting.

This approach offers many advantages over traditional aortic valve replacement, including longer valve life and no need for anticoagulation. These benefits are important for young patients and those who can get pregnant.

The Ross procedure has additional benefits, including:

• Reliability: A patient’s valve will work well and is protected from calcification or pannus formation, and there’s a decreased need for blood thinners or anticoagulants other than a baby aspirin.
• Silence: Mechanical valves produce an audible click that patients can hear. This can be distracting to patients.
• Survival advantage: Research shows that patients who have undergone the Ross procedure have a better survival rate than those who receive bioprosthetic or mechanical valves – comparable to people without aortic valve disease, when adjusted for age.

What Should a Patient Expect During the Ross Procedure?

Ross Procedure Preoperative Details

Patients will receive specific instructions before the Ross procedure, including risks such as bleeding, infection, and an adverse reaction to anesthesia, and will meet with the anesthesiologist prior to the surgery to review their medical history. Patients should not eat after midnight the night before the surgery. 

After the patient arrives at the hospital on the day of the surgery, a nurse will review the patient’s charts to make sure there are no problems. 

The anesthesiologist will then start an IV, and the patient will be taken to the operating room, where the surgeon will verify the patient’s name and procedure before any medication is given. Surgery will begin once the patient is under anesthesia.

Ross Procedure Operative Details

The Ross procedure involves extensive reconstruction and requires us to protect a patient’s heart for a long period during the procedure. We typically perform it with a full sternotomy (cutting through the breastbone) rather than a minimally invasive approach. We can shorten the skin incisions for cosmetic purposes.

The surgeon begins by making an incision in the breastbone and exposing the heart by spreading the rib cage. Once the surgeon reaches the heart, the patient is put on a cardiopulmonary bypass machine. This device pumps oxygenated blood through the body, bypassing the heart and lungs, so the surgeon can operate on the heart.

The surgeon then removes the pulmonary valve and a segment of the main pulmonary artery. This segment is used to replace the bad aortic valve. The diseased aortic valve, surrounding tissue, and aorta are removed, and the left and right coronary arteries are detached from the removed aorta.

The first pulmonic segment is then attached to the heart and aorta, with the left and right coronary arteries attached to this segment using stitches. Thus, the pulmonic segment replaces the aortic segment.

A separate pulmonic segment from a cadaver is then attached to the pulmonary artery and the heart.

The patient is taken off the cardiopulmonary bypass machine, so the patient’s heart can take over. The chest is then closed with temporary, precautionary pacing wires and chest tubes to allow blood drainage after the operation.

Ross Procedure Postoperative Details

After surgery, patients will be taken to the intensive care unit and monitored. Pain will be likely, and pain medication will be given as appropriate. Patients will be on a respirator for up to a day after surgery to help with breathing and will not be able to speak during this time.

The length of the hospital stay depends on how quickly the patient is able to recover and perform some physical activities.