Ross Procedure

Presentation by: Basem Almokhlaf

Noor Sulais

?What is a Ross Procedure

Removal

of the diseased aortic valve.

Replacement of the aortic valve with the
patients own pulmonic valve.
Left & right coronary arteries are attached to
the pulmonary valve root.
Replacement of the pulmonic valve with a
homograft/allograft.

Why make a patient a double valve

replacement when it is a single
?(aortic) valve problem
To help us understand, lets take a look a
little bit of background

Importance of the Aortic

Valve
Valve which
allows blood
to be pumped
forward to the
body & vital
organs.
When the
aortic valve is
damaged, the
circulation is
ineffective
due to
stenosis or
regurgitation.

What damages Aortic

?Valves
Rheumatic

fever.
Infection (endocarditis).
Degenerative processes
(calcifcation).
Congenital defects (two leaflet
{bicuspid} aortic valve).

Before the Ross

Procedure
Aortic

valve could be replaced

with:
Mechanical valve.

Xenograft (porcine or bovine) valve.

Homograft/Allograft (human cadaver)

Problems with Mechanical

Valves
Dont

grow with growing child.

Lifelong risk of thromboembolism.
Lifelong anticoagulation required.
Anticoagulation complications (i.e.
spontaneous bleeding).
Audible noise when valve.
closes (clicking sound) .
Risk of late infection
(prosthetic endocarditis).

Problems with Tissue

Valves
Degenerate

over time.
Most require replacement every 7
to 10 years.

Problems with Homografts

Sizing

and suturing cadaver heart

valves.
Procurement.
Preservation (Cellular elements
rendered non-viable).
Structural deterioration.
Difficult implant surgery.

History of the Ross

Procedure
Mr.

Donald Ross, working at

Guy's Hospital in London
became interested in replacing
the aortic valve with a human
graft .

He

thought best replacement

for a bad aortic valve was a
normal semilunar 3-leaflet
heart valve (i.e.
pulmonic).

Why use the Pulmonic

?Valve
Pulmonary

valve was designed the

same way nature intended for a
normal aortic valve to be

Provides

the best hemodynamic

and functional result, nearly
identical to a natural aortic valve
Pulmonic

First Ross Procedure

Performed by Mr. Ross at Guy's
Hospital on June 8, 1967
Patient lived more than 30 years after
transplantation without additional valve
replacement!

LE
T S
OV
DO
E
S RV
A
U R I EW Q U
GE
IC K
O
RY
FT
HE

Measurement of aortic
& pulmonic valves

Aortic valve removed & pulmonic

visually inspected

Autograft sutured in place

and coronary arteries are
re-attached

Pulmonary homograft is
attached to the right
ventricular outflow tract

Pulmonic valve removed &

placed in aortic position

Aorta attached to autograft

& pulmonary artery
attached to homograft

Problems with Ross

Procedure
Complex
procedure.

Longer time on
bypass
machine.
Replacement
homografts for
the donated
pulmonary
valve remain
relatively
scarce.

Absolute Contraindications for

Ross
Pulmonary

valve pathology.
Marfan Syndrome or other
connective tissue disorders.
Signifcant immune-complex
disease (leading to aortic valve
disease).

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