The Ross procedure is an advanced form of aortic valve replacement performed in the U.S. since the 1980s. It is essentially two surgeries in one, combining aortic replacement with secondary replacement of the pulmonary valve. While the Ross procedure is suitable only in certain cases, its results are in many ways superior to other valve replacement options.
Understanding Aortic Valve Replacement
The aortic valve is the heart's passageway to the aorta, the main artery supplying blood to the body. When this valve leaks or has difficulty opening and closing, strain is placed on the heart as it works harder to pump a normal volume of blood. Over time this extra stress may lead to heart failure. Aortic valve replacement is performed to provide a new valve that will allow the heart to return to a stable, healthy state.
Screening for the Ross Procedure
If you are less than 50 years old and in need of aortic replacement, your doctors may consider you for the Ross procedure. In addition to your age, they will take into account the condition of your pulmonary valve---the heart's passageway to the pulmonary artery, which supplies blood to the lungs. Since this valve will be needed as part of the Ross procedure, it must be well-developed and free of disease. You will also be checked for signs of any other tissue defect, such as Marfan's disease.
Surgery
If you are approved for surgery, your doctors will begin the procedure by removing your healthy pulmonary valve along with a section of the pulmonary artery. This pulmonary segment will then be temporarily set aside. Next, your doctors will remove the damaged aortic valve along with a small segment of the aorta. The right and left coronary arteries, which carry blood from the aorta to the exterior of the heart muscle, are also temporarily disconnected.
Next, your doctors will take the previously detached pulmonary segment---referred to as the pulmonary autograft---and attach it in the place vacated by the malfunctioning aortic valve. The disconnected coronary arteries are then connected to the pulmonary autograft. As a final step, your doctors will take a donated human pulmonary segment and attach it in place of the re-located pulmonary valve.
Post-operative Benefits
The Ross procedure is both lengthy and technically challenging, but once it is performed you will receive several benefits over other valve replacement methods. Since the replacement aortic valve is made from your own living tissue, it will typically adapt well to its new role and position. Also, you will not require the lifelong anticoagulant medication that comes with mechanical replacement options. Your replacement valve will also last well beyond the 7 to 10 year window provided by biological replacements made from non-human valves.
Post-operative Risks
The main danger of the Ross procedure is potential failure of the pulmonary autograft. While the valve itself usually performs well, the transplanted section of pulmonary artery is sometimes unable to handle the added pressure demands of blood flow in the aorta. Consult your doctors for more information on the risks and benefits of this surgery.
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