ros procedure.pptx
TRANSCRIPT
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