Ross procedure

Last revised by Rohit Sharma on 26 Feb 2018

Ross procedure involves the use of a pulmonary homograft for surgical aortic valve replacement.

It can be used to treat a broad array of aortic valve pathologies, often aortic stenosis.

  • multivessel coronary artery disease
  • multiple valvular pathologies in which a second valve replacement device is required
  • extremes of age
  • severely depressed left ventricular function

This involves the surgical replacement of the aortic valve and root with the patient’s native pulmonary valve and proximal pulmonary artery (homograft). Then the pulmonary valve and right ventricular outflow tract (RVOT) is replaced by a cadaveric pulmonary valve (allograft).

  • no need for anticoagulation
  • the valve grows as the patient grows in children
  • favorable hemodynamics
  • no prosthetic material present in the valve
  • potentially converting a single valve problem into a two valve problem

Reported complications include:

  • aortic insufficiency
  • right ventricular outlet obstruction and insufficiency
  • aortic autograft dilatation
  • pulmonary allograft stenosis
  • aneurysms

Cardiac MRI is useful for evaluating post-Ross procedure patients. The main limitation of the procedure is the need for reoperation in some patients.

This procedure was developed in 1967 by a British surgeon, Dr Donald Ross, and has undergone several refinements since.

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