Ross ProcedurePresentation by: Basem Almokhlafi

Noor Sulais

What is a Ross Procedure? Removal of the diseased aortic valve. Replacement of the aortic valve with the

patient’s 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, let’s 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

(calcification).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) valve.

Problems with Mechanical ValvesDon’t 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 ValvesDegenerate over time.Most require replacement every 7

to 10 years.

Problems with HomograftsSizing 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!

LET’S DO A QUICK

OVERVIEW OF THE

SURGERY

…

Measurement of aortic & pulmonic valves

Autograft sutured in place and coronary arteries are

re-attached

Aortic valve removed & pulmonic visually inspected

Pulmonic valve removed & placed in aortic position

Aorta attached to autograft & pulmonary artery

attached to homograft

Pulmonary homograft is attached to the right

ventricular outflow tract

Problems with Ross Procedure

Complex procedure.

Longer time on bypass

machine.

Replacement homografts for

the donated pulmonary

valve remain relatively scarce.

Absolute Contraindications for RossPulmonary valve pathology.Marfan Syndrome or other

connective tissue disorders.Significant immune-complex

disease (leading to aortic valve disease).

Think you for listening