The Ross procedure is a major heart surgery. It involves replacing an abnormal aortic valve with a valve from the other side of the heart.

The Ross procedure is a type of aortic valve replacement surgery.

The heart is a muscle responsible for pumping blood throughout the body. It has four valves that prevent blood from traveling backward. Irregularities in these valves affect the way blood moves through the chambers of the heart and major blood vessels and can require the heart to work harder.

This extra pressure on the heart can contribute to severe heart problems later on, such as heart failure. However, aortic valve replacements can help reduce pressure on the heart.

This article explains the Ross procedure, how to prepare for it, what to expect, and its benefits and risks.

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The Ross procedure is useful for replacing a damaged aortic valve. The aortic and pulmonary valves have similar shapes, so a surgeon can use the pulmonary valve to replace the aortic valve. The surgeon can then implant a donor valve in the pulmonary valve’s previous position.

The Ross procedure involves the following steps:

  1. The surgeon cuts through the breast bone.
  2. The medical team inserts tubes into the heart and the surrounding major blood vessels. These connect to a heart-lung machine that takes over the heart’s blood-pumping role during surgery.
  3. The medical team stops the heart using medication.
  4. The surgeon clamps shut the aorta, which is the heart’s main artery.
  5. The surgeon opens the heart and removes the faulty aortic valve.
  6. The surgeon moves the pulmonary valve to the location of the removed aortic valve.
  7. The medical team implants a valve from a donor in the previous location of the pulmonary valve.
  8. The medical team restarts the heart with controlled electric shocks.
  9. The surgeon uses wire to close the breast bone.

The most common condition for which doctors recommend the Ross procedure is aortic valve disease in children with congenital aortic stenosis. Aortic stenosis causes narrowing of the aortic valve opening, which reduces the amount of blood that moves from the left ventricle to the aorta.

Aortic stenosis is a serious heart problem that can lead to heart failure. While this condition is more common in older adults, some people may have it at birth. It may not cause symptoms or become noticeable for 10–20 years.

In children who are not yet fully grown, the pulmonary valve can continue to grow in its new position after the Ross procedure.

The Ross procedure can also help with other conditions, such as:

  • bicuspid aortic valve, a congenital heart anomaly
  • some types of left ventricular outflow obstructive disease
  • valve endocarditis, an infection of the heart valve’s lining that can be fatal without treatment
  • some forms of adult aortic regurgitation with a dilated aorta, in which a weak or wide aorta leaks blood back into the left ventricle
  • severe forms of aortic valve disease that are not responding to or suitable for repair procedures

The Ross procedure is effective because the donor valve is under less stress in the pulmonary position than it would be if surgeons used it as a direct replacement for the aortic valve.

The aortic valve’s role requires far more pressure to pump blood to the rest of the body. The pulmonary valve can handle the high volume of blood flow in its new position. Meanwhile, the donor valve is more likely to succeed in a position that requires less pressure.

A person’s doctor can discuss with them the Ross procedure’s possible benefits for their condition so that the person can make an informed decision about their treatment plan.

People preparing for the Ross procedure should speak with their cardiologist — a doctor specializing in heart health — about specific steps they may need to take before surgery.

They might need to stop taking medication beforehand. A person’s doctor can also inform them about when they should last eat and drink before the procedure.

If a person smokes, doctors will usually ask them to stop smoking in advance of the surgery. Smoking can increase the risk of complications.

A person may also need to pack clothes and belongings to last them for a week, as this is the usual amount of time they will spend in the hospital. A person’s doctor can provide them with more accurate information about how long they can expect to stay in the hospital after the procedure.

After an aortic valve replacement, people spend around 1 week in the hospital. The length of time may vary depending on age and overall health. The first 1 or 2 days of this time will involve close monitoring in the intensive care unit (ICU).

During admission to the ICU, a person will be connected to a ventilator machine that supports breathing until they can breathe on their own. They will not be able to eat, drink, or speak during this time.

Afterward, the medical team will transfer the person to the surgical ward for the next days of their recovery.

After leaving the hospital, a person may need to avoid driving, sexual intercourse, and manual labor for several weeks or months. They may be able to resume light exercise, such as walking, when they feel comfortable doing so. A doctor may also recommend cardiac rehabilitation to help improve a person’s heart health.

People need lifelong monitoring after the Ross procedure.

Like any surgery, the Ross procedure poses some risk of complications. Possible complications include:

A person can discuss the possible complications with their doctor beforehand. It is also important that a person seek immediate medical help if they experience any serious complications.

Here are some frequently asked questions about the Ross procedure.

Who is eligible for the Ross procedure?

According to a 2021 research article, the Ross procedure is ideally suitable for people who have a projected life expectancy of 15 years or longer and have an aorta of typical size. Doctors most commonly use this procedure to treat aortic valve disease, particularly isolated aortic stenosis.

How rare is a Ross procedure?

Less than 0.1% of all aortic valve replacements in the United States involve the Ross procedure. This is because most cases of aortic valve stenosis occur later in life, and the Ross procedure is typically not suitable for older people.

What is the life expectancy for a person after the Ross procedure?

Around 80–90% of people who receive the Ross procedure live for at least 10 years afterward, and 70–80% live for 20 years. The Ross procedure may help restore life expectancy for children and young adults with aortic stenosis.

The Ross procedure is an intensive heart surgery for aortic stenosis that usually requires a weeklong hospital stay. It involves removing the aortic valve and moving the pulmonary valve to its former location.

People who undergo the Ross procedure usually need lifelong monitoring afterward. Full recovery can take several months.

Survival rates are generally very good, and a child or young adult who undergoes the Ross procedure may have a typical life expectancy.