Heart Surgery

Ross Procedure

The Ross procedure is a type of heart valve replacement surgery for the treatment of a damaged or diseased aortic valve, the main valve that sends blood from the heart to the rest of the body. A diseased or damaged aortic valve can impede the flow of blood from the heart to the rest of the body. The Ross procedure has an excellent success rate in restoring normal life expectancy to many people with severe aortic valve disease. The surgery is appropriate for patients of a wide age range – from infants to active adults aged 60 or younger.

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What Is the Ross Procedure?

In the Ross procedure, a surgeon removes the diseased or damaged aortic valve and replaces it with the patient’s own pulmonary valve, which sends deoxygenated blood to the lungs to be oxygenated. The replacement is possible because the pulmonary valve is similarly shaped to the aortic valve. As part of the procedure, the surgeon replaces the relocated pulmonary valve with a pulmonary valve from a donor.

In general, the pulmonary valve is under less stress than the aortic valve because the heart’s right chamber does not need to generate as much force in pushing blood to the lungs. As such, a donor valve that replaces the pulmonary valve is more likely to be successful than one that replaces the aortic valve.

After the procedure, the relocated pulmonary valve can continue to grow normally in a baby or child while handling the high volume of blood that flows from the lower pumping chamber out to the body. Unlike other heart valve replacement procedures, people who receive the Ross procedure usually do not have to take long-term medications to preserve the health of the replaced valve.

Who’s Eligible for the Ross Procedure?

You may be a suitable candidate for the Ross procedure if you are younger than 60 years old and have:

  • Congenital or acquired aortic stenosis: a condition in which the flaps (leaflets) of the aortic valve become stiff, so that the valve is unable to open and close fully. Consequently, the heart must work harder to pump blood to the rest of the body.
  • Aortic valve endocarditis: an inflammation of the inner lining of the aortic valve usually caused by infection.
  • Other types of aortic valve disease.

Why Get Your Ross Procedure at University Hospitals Harrington Heart & Vascular Institute?

With a dedicated commitment to improving heart health across northeast Ohio, the specialists at UH Harrington Heart & Vascular Institute are nationally renowned for excellence in the diagnosis and treatment of all types of heart valve disease. We have extensive experience in performing successful Ross procedures and other complex heart valve surgeries. Our Valve and Structural Heart Disease Center brings together a talented, multidisciplinary team that works to identify heart valve disease earlier for improved quality of life.

What Diagnostic Tests Are Given Prior to a Ross Procedure?

In addition to having an aortic disease diagnosis, in order to be approved for a Ross procedure, a patient must have a well-functioning pulmonary valve. Our surgeons use diagnostic tests to evaluate your heart valves before approving the surgery. These tests include:

  • Chest X-rays: The purpose of chest x-rays is to gain insight into the size and shape of the heart.
  • Cardiac Computed tomography (CT) scans: Using x-ray imaging technology, our team creates cross-sectional images of the heart.
  • Echocardiograms (Echo): Echocardiograms evaluate heart anatomy, heart valve function and blood flow through the heart.
  • Electrocardiogram (ECG): An ECG can uncover issues with heart rhythm by recording the electrical activity generated by the heart muscle.

What Happens During the Ross Procedure?

The Ross procedure is an open-heart surgery that takes from 8 to 12 hours to complete:

  • You are given general anesthesia, which puts you to sleep and temporarily blocks sensation; as a result, you will have no memory of the procedure.
  • The surgical team places you on a heart-lung (cardiopulmonary) bypass machine, which allows for your heart to be safely stopped. The machine temporarily takes over the function of your heart and lungs during surgery.
  • Surgeons make an incision down your chest and separate your breastbone (sternotomy) to given them access to your heart.
  • The surgeons inspect the pulmonary valve to check that it is healthy enough to replace the aortic valve.
  • The surgeons remove the damaged aortic valve.
  • The surgeons remove the pulmonary valve and attach it in the aortic valve position.
  • The surgeons insert a donor pulmonary valve into the pulmonary valve position.
  • With the new valves in place, your care team restarts your heart and slowly takes you off the heart-lung bypass machine.
  • Your team checks that the aortic and pulmonary valves are working properly.
  • The surgeons set your breastbone back in place and close it with wires. The incisions are closed with stitches and a surgical dressing is applied to protect the area.

Recovery After a Ross Procedure

Following your surgery, you will be taken to the cardiac intensive care unit (ICU) for recovery. Your breathing tube is removed usually after 4 to 5 hours when you can breathe again on your own. Expect to stay in the ICU for up to five days. Patients typically spend 1 to 2 weeks in the hospital before they can go home.

Your cardiologist will instruct you to restrict your physical activity for up to eight weeks following your operation. Your complete recovery may last several months. During that time, you may experience:

  • Numbness and swelling near the incision
  • Depression
  • Insomnia
  • Loss of appetite
  • Constipation

In addition to short-term life-style modifications, your doctor may prescribe certain medications for a few weeks following the procedure, including:

  • Diuretics (water pills) so prevent your body from retaining water.
  • Pain medication (in decreasing amounts).
  • Beta blockers to assist in keeping your blood pressure low while your pulmonary valve adjusts to its new role in the aortic valve position.
  • Angiotensin enzyme inhibitors for additional blood pressure control or if you experience severe aortic regurgitation with dilated left ventricles.

Patients who get a Ross procedure require lifelong monitoring to test their valve function. An aortic valve replaced via the Ross procedure usually needs to be replaced within 15 to 20 years. Regular monitoring will ensure that you receive a replacement at the right time. Aortic valve replacement of a valve obtained through a Ross procedure is often accomplished through minimally invasive techniques that provide a quick recovery.

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Schedule online with a cardiologist