The Ross Procedure

W. Hampton Gray, MD, Vaughn A. Starnes, MD, S. Ram Kumar, MD, PhD


The Ross procedure, first performed in 1967, replaces the diseased aortic valve with the patient’s own pulmonary valve. The complexity of the operation has limited its widespread use and, in the current era, the majority of these operations are performed at high volume centers. The anatomic relationship between the aortic valve, pulmonary valve, and left coronary system is paramount to the conduct of the operation and a successful outcome. In general, patients who undergo the Ross procedure are younger, more active, and have a reasonably long life expectancy; however, the Ross procedure can be utilized across all age groups, and it allows for an active lifestyle without the need for anticoagulation. Although originally described as a subcoronary implant, the majority of surgeons today perform the Ross operation using a full root replacement technique with various modifications for autograft support. Postoperative blood pressure control is important as is long-term follow-up for late autograft dilation and development of neoaortic insufficiency, which is the most common reason for reintervention on the autograft. With the right care, overall mortality is extremely low and survival is comparable with that of the general population.

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Last updated: January 18, 2021