My Ross Procedure

My Ross Procedure > What Is The Ross Procedure?

What Is The Ross Procedure?

The ross procedure, also known as pulmonary valve translocation, was developed by Dr. Donald Ross in 1967. The procedure addresses many of the problems of other aortic valve replacements. While mechanical valves will theoretically last forever, they do not always provide optimal performance and require the lifelong use of anticoagulants (blood thinning drugs) to prevent the formation of blood clots. Tissue valves such as pig valves and even human tissue valves have shown poor durability as replacements for the aortic valve.

The Ross Procedure, however, uses the patient's own pulmonary valve (the autograft valve) and the surrounding pulmonary artery as a unit to replace the aortic valve and surrounding aortic artery. The pulmonary valve is identical in shape, size, and strength to the aortic valve, and is therefore an ideal candidate to replace it. A donor tissue valve is then placed in the pulmonary position. Since the pulmonary valve does not undergo the much higher stress endured by the aortic valve, the donor valve (the homograft valve) can usually function in the pulmonary position with no calcification or degeneration. Even if some degeneration does occur, many patients can still lead a normal life with no effects. Occasionally the homograft valve in the pulmonary position will need replacement, but this is considered to be a much easier surgery than aortic valve replacement.

The surgery has shown many other benefits. Children who have had the Ross Procedure have shown growth in the autograft valve. The Ross is also a good alternative for women who are planning on having children, since it does not require the use of anticoagulants.

Dr. Ross published long term results in 1991 that were based on review of 339 patients that were followed for up to 24 years. Twenty years after the procedure, 80 percent were alive and 85 percent had not required reoperation. Hopefully, improvements in both surgical techniques and cryogenic preservation of the donor tissue valves will increase these rates on patients who have recently undergone surgery.

Diagrams

The pulmonary valve and a segment of the pulmonary artery are excised. The pulmonary segment and valve will then be placed in the aortic position, replacing the diseased aortic valve and a segment of the aortic artery.

The diseased aortic valve and artery tissue is removed. The coronary arteries must be detached from the aortic artery.

The pulmonary autograft is placed in the aortic position, and the coronary arteries are reattached. A cadaveric pulmonary valve and artery homograft is then placed in the pulmonary position to replace the excised pulmonary segment. A homograft valve is used because it is known to provide a longer life expectancy than if it were placed in the aortic position, and because it is generally not clinically feasible for a prosthetic valve to function well in the pulmonary position.

Images Courtesy of USC University Hospital Quarterly Magazine