The Ross Procedure
In the Ross Procedure 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 life time for many patients. The Ross Proceedure is a much more physiological procedure compared to valve replacement with other available prostheses, and patients are able to regain normal exercise capability and participate in sporting activities which might not be possible with other prostheses.
The major advantage is that the patient has a durable tissue valve substitute, and does not need to take Warfarin at all, with all its attendant complications. 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. The only potential disadvantage is that patients require follow up of both aortic and pulmonary valves. However 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). The risk does increase with older patients, those with other co-morbidities (eg. lung and kidney disease), and if other cardiac procedures are required simultaneously (eg. coronary artery bypass surgery).
Applicable Age Range 15 – 65
- Warfarin is not required at any stage therefore patients have an excellent quality of life without blood tests or anticoagulation related complications.
- Best durability of any tissue (non-mechanical valve).
- “Viable” valve substitute.
- Longer, more complex operation (4-5 hours versus 3 hours for a mechanical valve).
- Should be performed by experienced operator.
- Follow up of both aortic and pulmonary valves required, although the pulmonary valve re-operation rate is extremely low.
In patients under the age of 65 years, operative risk is 1% regardless of procedure. The major post-operative risk is that of cerebro-vascular accident (CVA, stroke) which occurs in an additional 1%. Other complications include necessity for permanent pacemaker (1%), and sternal wound infection (0.5%).