The Ross procedure: suitable for everyone?

Abstract

In 1967, Donald Ross transferred the patient’s own pulmonary valve into the aortic root. Although results of this technique were encouraging, the Ross procedure did not gain widespread popularity until the late 1980s when surgeons started to implant the pulmonary autograft as a freestanding full root replacement with reimplantation of the coronary arteries. However, frequent dilatation of the pulmonary autograft was observed using the freestanding full root replacement technique. In contrast, the original subcoronary implantation technique and aortic root inclusion technique prevented dilatation in the long-term. Through advancing know-how in aortic root surgery and confidence, the Ross procedure has also been used in combined procedures and complex clinical presentations with good long-term results, which encourage continual use. However, the Ross procedure is a complex operation; careful patient selection and experience of the surgeon are mandatory requirements to achieve satisfactory results.

Keywords::

• aortic valve replacement
• homograft
• neoaortic regurgitation
• pulmonary autograft
• root replacement technique
• Ross procedure
• subcoronary implantation technique

Acknowledgements

The authors would like to thank Mrs. Kreutzer for the preparation of the schematic drawings.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Autograft regurgitation remains the crucial weak point of the Ross procedure.

• The long-term success of external support techniques to prevent autograft regurgitation in adults is unknown.

• Alternative techniques for right ventricular outflow tract reconstruction must be taken into consideration, such as implantation of tissue-engineered valves, to improve long-term results.

• It is to be expected that future bioprosthetic valves will demonstrate improved long-term results in the aortic position so that the Ross procedure may lose its important position in aortic valve surgery.