The Ross Procedure

Abstract

The Ross procedure consists in replacing the diseased aortic valve with the patient’s own pulmonary valve and simultaneous replacement of the pulmonary valve (and root) with a pulmonary homograft (or in some cases a xenograft). Pulmonary autograft in aortic position is a viable valve with excellent haemodynamics, low thromboembolic risk, resistance to infection and growth potential. These features make this procedure an ideal solution in paediatric aortic valve surgery. In adult patients, Ross procedure has been a subject to controversial debate over decades, with concerns raised over its complexity and for the two valves at potential risk in the long term. Current data, however, document superior long-term results, physiological haemodynamics and high quality of life without need of anticoagulation. In the light of these results, Ross procedure is an optimal option for young adults, women planning pregnancy and individuals with adherence to active life-style. A prerequisite for these beneficial outcomes is a meticulous surgical technique, the important details of which are discussed in the chapter.