The Ross procedure does not cause hemolysis and eliminates the need for patients to take blood thinners for the rest of their lives.

The Ross operation is an extremely complex procedure developed for individuals who require a new aortic valve. The Ross procedure was developed in 1967 by a British surgeon, Dr. Donald Ross, and has undergone refinements since the first operation.

In the Ross procedure, the diseased aortic valve is removed and replaced with the patient’s own pulmonary valve (autograft). After the pulmonary valve is transferred to the aortic position, a pulmonary homograft from a donor (human cadaver) valve is sewn into the pulmonary position, and the coronary arteries are re-implanted. The Ross procedure is especially well suited to young individuals.

Advantages of the Ross procedure

• Anticoagulants (blood thinners, such as Warfarin) are not necessary. Blood thinners increase the risk of bleeding, and may lead to a stroke or other medical problems. In addition, blood thinners cannot be used in women who may become pregnant as they cause severe damage to an unborn child.
• Thromboembolic complications are near zero.
• The risk of endocarditis is reduced.
• The natural valve is superior in hemodynamics to prosthetic or bioprosthetic valves.
• The autograft has the potential to grow as the child grows (which artificial valves cannot do).
• Patients’ activities do not need to be limited.

Ross procedure candidates are:

• Infants
• Young people who are very active and do not want to take blood thinner medication for the rest of their lives
• Young women who want to become pregnant
• Middle-aged active people

Disadvantages to the Ross procedure

The Ross procedure is technically much more demanding than conventional aortic valve replacement. Not all patients are a candidate for the Ross procedure and both the autograft in the aortic position and the valve substitute in the right ventricular outflow tract (RVOT) may develop structural failure over time.

The patient should expect to remain for 7 days in hospital. The risk of complications, albeit in a small percentage, include a stroke, heart attack, bleeding and infection.

At 15 years, the freedom from reoperation on the pulmonary autograft was 92%, the freedom from reoperation in the pulmonary valve was 97%, and the freedom from any cardiac reoperation was 85%.