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What is the Ross Procedure?

The aortic valve controls blood flow from the heart to the rest of the body. The Ross procedure is a heart valve surgery used to treat a damaged aortic valve. During this procedure, a surgeon replaces the damaged aortic valve with the patient’s own pulmonary valve. The pulmonary valve is similar in shape and function and can often work well in the aortic position.

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How is the Ross procedure performed?

The Ross procedure is a major open-heart surgery performed while the patient is under general anesthesia.

During the procedure:

• The surgeon removes the diseased aortic valve.
• The patient’s pulmonary valve is moved into the aortic valve position.
• A donor pulmonary valve is placed where the patient’s pulmonary valve was removed.
• The coronary arteries are reattached to the new aortic root.
• The surgical team checks that both valves are working properly before completing the operation.

Why does the Ross Procedure work?

The pulmonary valve normally works under lower pressure because the right side of the heart does not need to pump as hard to move blood to the lungs. When this valve is moved to replace the aortic valve, it can function well in its new position. A donor valve placed in the pulmonary position may also last longer because that valve is exposed to less stress.

What are the benefits and risks of the Ross procedure?

The Ross procedure offers several potential benefits. In children, the moved pulmonary valve can continue to grow as the child grows. It can also adapt well to the high blood flow needed in the aortic valve position.

Unlike a mechanical valve, the Ross procedure usually does not require lifelong anticoagulant medication.

Studies show that the Ross procedure can work well for 15 to 20 years.

In adults, the procedure has been associated with a lower risk of some valve-related complications, including stroke and major bleeding, compared with mechanical valve replacement.

As with any major heart surgery, the Ross procedure carries risks. Clinical guidelines recommend that it be performed at a Comprehensive Valve Center by a surgeon with experience performing the procedure.

Over time, the moved pulmonary valve may begin to leak in its new position, and the donor pulmonary valve can become narrowed or leak. In some cases, additional catheter-based treatments or repeat surgery may be needed.

What makes someone a good candidate for the Ross procedure?

The Ross Procedure is typically considered for younger people with aortic valve disease who want a biologic (living tissue) valve instead of a mechanical valve. It may be an option for people who:

• Are younger than 50
• Prefer a biologic valve and want to avoid a mechanical valve
• Cannot take anticoagulants or want to avoid lifelong anticoagulant therapy
• Have a healthy pulmonary valve that can be used to replace the aortic valve
• Have access to an experienced Ross surgeon at a Comprehensive Valve Center

The Ross procedure may not be appropriate for people with certain conditions, including:

• Pulmonary valve disease
• Marfan syndrome
• Advanced coronary artery disease
• Significant mitral valve disease
• Lupus or other immune disorders
• Rheumatic valve disease
• An enlarged or abnormally shaped aortic root

Are there other situations where the Ross procedure may be considered?

In some cases, the Ross procedure may be considered for:

• Women with bicuspid aortic valve disease and a small aortic valve opening who are considering pregnancy and want to avoid a mechanical valve and lifelong anticoagulant therapy
• People with certain blockages in the pathway that carries blood from the heart to the body
• People with endocarditis affecting a native or replacement prosthetic valve, depending on the extent of the infection
• Adults with some forms of aortic regurgitation and an enlarged aorta
• People with severe aortic valve disease that cannot be repaired

Pre-surgery Checklist English  (PDF) | Pre-surgery Checklist Spanish (PDF) 
Recovery Tracker English (PDF) | Recovery Tracker Spanish (PDF)