Ross procedure: Restoring your lifestyle with innovative valve surgery

The replaced valve does not require blood-thinning medications, and in young and middle-aged adult patients leads to superior long-term outcomes compared to the currently available mechanical and biologic replacement valves.

When you get the Ross procedure, you can return to a normal active lifestyle without restrictions and pursue sports and hobbies without limitations and concerns imposed by valve related medications. Teens and adults between the ages of 18 and 50 benefit the most from this treatment.

Your aortic valve sits between the left ventricle of your heart and the aorta. The aorta carries blood from the heart to the rest of your body. When the left ventricle squeezes, it pumps blood through the aortic valve. A healthy aortic valve snaps tightly shut as the left ventricle fills with blood.

Although most patients have three flaps in their aortic valves, about 5% of patients have only two — that is called a bicuspid aortic valve and leads to early wear and tear and damage. Other reasons can lead to damage even in three-flap aortic valves as well. A damaged aortic valve can leak blood. It can also become stiff or not close all the way, putting a lot of stress on your heart.

Your pulmonary valve sits between your heart’s right ventricle and pulmonary artery. It helps with the effective pumping of blood from your heart into your lungs. The pulmonary valve has three flaps and similar configuration with the aortic valve, and has many characteristics that make it an ideal replacement for a damaged aortic valve.

During a Ross procedure, your surgeon:

• Removes your damaged aortic valve 

• Detaches your pulmonary valve and places it where the aortic valve sits

• Transplants a donated human pulmonary valve to replace your pulmonary valve

Who is it for? 

The Ross procedure works well for children and teens who need a new aortic valve due to narrowing or leaking. Artificial valve options are limited for younger patients.

Patients younger than 50 who want to avoid taking blood thinners and want to pursue an active lifestyle without limitations are also good candidates for this treatment.

Is the procedure right for you?

If you or your child need an aortic valve replacement, your care team will discuss your treatment options. Your doctor will consider your age and the health of your pulmonary valve before deciding if the Ross procedure is the best option for you.

You go to the hospital the morning of your surgery. The Ross procedure is open-heart surgery. A patient is generally in the operating room 8-12 hours.

Here’s what to expect:

• You go to sleep with general anesthesia

• Your blood circulates through a machine so that your heart can be stopped for the procedure

• The surgeon makes small cuts in your heart to reach the valves

• Your surgeon checks the pulmonary valve to make sure it is healthy

• The surgeon removes your damaged aortic valve

• Your surgeon removes the pulmonary valve and places it where the aortic valve sits

• The surgeon inserts a donor pulmonary valve to replace your pulmonary valve

• You slowly come off the heart pump machine as your heart begins working again

• Your care team tests each valve to make sure they work properly

• You go to the ICU for recovery

• The breathing tube is removed after 4-5 hours, once you can breathe again on your own

You spend 1-2 weeks in the hospital before you can go home.

Your recovery after valve replacement

You feel stronger every day after your surgery. It takes about 12 weeks for your breastbone to heal. As you recover you should:

• Attend all of your follow-up appointments

• Take medications as prescribed

• Be as active as you can while following the precautions taught to you in the hospital

• Walk every day

• Take your blood pressure as directed

How the Ross procedure restores your health

You gain many health benefits from the Ross procedure, including:

• Excellent blood flow at rest and during exercise

• Less likely to require long-term, blood-thinning medicines

• Normal life expectancy

• Improved quality of life

• Low risk of blood clots or infection

In pediatric patients who get a Ross procedure, the child’s pulmonary valve continues to grow normally in the aortic valve position. 

A donated pulmonary valve performs well in children and adults for up to two decades and often can be replaced with a minimally invasive catheter-based procedure without need for further open-heart surgery.