michael s
(Michael S)
#1
43 What is the Ross procedure? When is it
indicated and what are the advantages?
R Cesnjevar and Victor T Tsang
What is the Ross procedure?
The Ross procedure, or pulmonary autograft procedure, was
introduced by Mr Donald Ross in 1967. The operation is
performed via median sternotomy on cardiopulmonary bypass.
The principle is to replace the diseased aortic valve with the
autologous pulmonary valve. The pulmonary autograft is placed
in the aortic position as a root replacement with interrupted
sutures and the coronary arteries are reimplanted. Great care must
be taken during harvesting of the pulmonary root because of the
close proximity of the first septal branch of the left anterior
descending coronary artery. A homograft (preferably pulmonary)
is used to restore continuity between the right ventricular outflow
tract and the pulmonary artery. The overall operative risk cited in
the current literature is 1.5–7.0%, depending on the patient’s age
and surgical indication.
In whom should I consider it?
The Ross procedure is the preferred option for aortic valve
replacement in the growing child due to the growth potential of
the implanted autograft. It should also be considered in any
patient where anticoagulation is completely or relatively
contraindicated. Another possible indication is active endo-
carditis because of its “curative” potential. The likelihood of
recurrence of endocarditis and of perivalvar leak is lower in
patients after a Ross procedure, compared to mechanical valve
replacement.
What are the advantages?
The haemodynamic performance of the autograft valve is superior
to mechanical valves, with much lower transvalvar gradients and
better regression in ventricular size and hypertrophy in the mid-
term. Anticoagulation with warfarin (a major contributor to
mechanical valve-related morbidity and mortality) is not required
