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The Ross Procedure

The Ross Procedure is a type of specialized aortic valve surgery where the patient's diseased aortic valve is replaced with his or her own pulmonary valve. The pulmonary valve is then replaced with cryopreserved cadaveric pulmonary valve. In children and young adults, or older particularly active patients, this procedure offers several advantages over traditional aortic valve replacement with manufactured prostheses.

Heart illustration showing the aortic valve and pulmonary valve.

Fig. A: The pulmonary valve and a segment of the pulmonary artery are excised. This pulmonary segment will later be placed in the aortic position replacing the diseased aortic valve.

Heart illustration showing the right coronary artery, pulmonary autograft, and left coronary artery.

Fig. B: The diseased aortic valve and proximal tissue is removed, leaving the right and left coronary arteries with only a button of tissue.

 autograft root, right coronary artery, allograft, and left coronary artery.

Fig. C: The pulmonary autograft is placed in the aortic position and the buttons of tissue on both the right and left coronary arteries are then sewn into that pulmonary segment and closed. A cadaveric pulmonary valve and artery homograft is then replaced in the pulmonary position to replace the excised pulmonary segment.

Longevity of the pulmonary autograft in the aortic position is superior to bioprostheses such as porcine valves, which tend to degenerate after only a few years in patients under 35 years of age. Furthermore, anticoagulation is not required as with mechanical valves. Thus, individuals can lead an active life without the risks associated with anticoagulation therapy. This is especially important for women of child bearing age needing aortic valve replacement, as anticoagulation is contraindicated in pregnancy.

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