Table of ContentsView AllTable of ContentsWhat Is the Procedure?Qualifying for ItRoss Procedure Recovery
Table of ContentsView All
View All
Table of Contents
What Is the Procedure?
Qualifying for It
Ross Procedure Recovery
The Ross procedure is a type of heart surgery that is used toreplace a damaged aortic valve. The aortic valve allows blood to move from your heart into youraorta. Your aorta carries blood from your heart to the rest of your body.
The Ross procedure removes the diseased aortic valve and replaces it with your own pulmonary valve. A donor pulmonary valve replaces your own.
This procedure works best for active, healthy people under age 60. It may also be an option for teens, children, and some babies under 1 year old.
This article describes the Ross procedure and how it compares to other treatments. It explains who qualifies and what to expect as you recover.
Ross Procedure vs. Other Heart Surgeries
The Ross procedure is just one surgical option for aortic valve replacement. Replacement is necessary when repairing a damaged aortic valve will not restore the valve to its normal function. Aortic valve replacement surgery can be performed using traditional open techniques or minimally invasive methods.
There are also several options regarding the type of valves used in aortic valve replacement surgery. These options include:
Mechanical valves: These valves are manufactured from long-lasting mechanical parts, which are intended to last a lifetime. Most people with mechanical valve replacements have to take ananticoagulant(blood thinner) medication such asJantoven(warfarin)for the rest of their lives. This reduces the risk of clots forming and becoming lodged in the valve flaps or hinges and causing a malfunction.
Biological valves: These valves, also called tissue or bioprosthetic valves, are made from pig tissue (porcine), cow tissue pericardial (bovine), or pericardial tissue from other species. They may also contain some artificial components to provide additional support and allow the valve to be sewn into place. While these valves don’t last as long as mechanical valves, they do not require the lifetime use of anticoagulants.
Homograft: Also called an allograft, this type of aortic or pulmonic valve has been removed from a donated heart. The replacement valve is preserved with antibiotics and frozen until needed. Homografts are ideal valves for aortic valve replacement, especially when the aortic root is diseased orendocarditis(infection) is present. Taking anticoagulants is not necessary.
Conditions Treated
The Ross procedure and other aortic valve replacement surgeries are used when a damaged or diseased aortic valve can’t be repaired.
Without replacement, aortic diseases force your heart to pump harder to provide the blood that the rest of your body needs to function normally. Replacing a damaged aortic valve restores function and reduces the risk of heart failure and other types of heart disease.
Aortic valve replacement surgeries are used to treat dysfunctional aortic valves that occur due to the following conditions, which may occur as congenital (present at birth) or acquired problems:
Aortic stenosis and aortic insufficiency can affect your aortic valve at the same time.
What Is Heart Valve Disease?
Surgical Techniques
Surgical techniques for aortic valve replacement include the following:
Open Heart Surgery
Open heart surgeryinvolves making an incision through the chest. Your breastbone is divided so your surgeon can see and gain direct access to your heart and aorta.
Two types of open heart surgery for aortic valve replacement include:
Minimally Invasive Surgery
Minimally invasive surgeryis a type of surgery that involves smaller incisions and shorter recovery times. These procedures are also known as laparoscopic or keyhole procedures.
Two types of minimally invasive surgery for aortic valve replacement include:
Surgery Success and Risks
Traditional Aortic Valve Surgery
Ross Procedure
Minimally Invasive Aortic Surgery
TAVR/TAVI
Comparing Heart Surgery OptionsThere is no one-size-fits-all technique for aortic valve replacement. Your surgeon determines the treatment most appropriate for your condition based on the following factors:Your age, general health, and medical historyPrevious heart treatments or valve replacementsThe severity of your diseaseYour signs and symptomsYour tolerance for specific procedures, medications, and/or therapiesYour expectations for the course of the diseaseYour lifestyleYour preferences
Comparing Heart Surgery Options
There is no one-size-fits-all technique for aortic valve replacement. Your surgeon determines the treatment most appropriate for your condition based on the following factors:Your age, general health, and medical historyPrevious heart treatments or valve replacementsThe severity of your diseaseYour signs and symptomsYour tolerance for specific procedures, medications, and/or therapiesYour expectations for the course of the diseaseYour lifestyleYour preferences
There is no one-size-fits-all technique for aortic valve replacement. Your surgeon determines the treatment most appropriate for your condition based on the following factors:
The Ross procedure involves removing a diseased aortic valve and replacing it with your own pulmonary valve. Relocating the pulmonary valve is possible because it is anatomically similar to an aortic valve.
As the relocated pulmonary valve adjusts to its new position, it becomes thicker and stronger. Within a few months, it functions like a healthy aortic valve.
The space left from your relocated pulmonary valve is filled with a pulmonary valve from a donor heart. Since the pulmonary valve doesn’t have to generate as much force to push blood to the lungs, the demands can usually be met with a replacement valve.
A Ross procedure can take six to eight hours. It involves the following steps:
How to Qualify for the Ross Procedure
Your cardiac surgeon will carefully evaluate your condition to determine whether you qualify for the Ross procedure. While you may meet the criteria for the Ross procedure, factors such as the type of valvular dysfunction present, the presence of other medical conditions, and lifestyle considerations are carefully weighed.
Generally, the Ross procedure is reserved for people with aortic valve disease, such as aortic stenosis or aortic insufficiency, who meet the following criteria:
People in the following groups who meet the procedure criteria are likely to experience the most benefits of a Ross procedure:
The Ross procedure is not an option for people who have the following conditions:
Finding a Specialized Care Team/SurgeonDespite its successful outcomes, few surgeons use the procedure due to its complexity. It represents just 0.09% of all aortic valve replacements performed in the United States. Talk to your cardiologist to find a surgeon that specializes in the Ross procedure.You can also consult thedirectory of Ross procedure surgeonsto locate a Ross procedure surgeon in your area.
Finding a Specialized Care Team/Surgeon
Despite its successful outcomes, few surgeons use the procedure due to its complexity. It represents just 0.09% of all aortic valve replacements performed in the United States. Talk to your cardiologist to find a surgeon that specializes in the Ross procedure.You can also consult thedirectory of Ross procedure surgeonsto locate a Ross procedure surgeon in your area.
Despite its successful outcomes, few surgeons use the procedure due to its complexity. It represents just 0.09% of all aortic valve replacements performed in the United States. Talk to your cardiologist to find a surgeon that specializes in the Ross procedure.
You can also consult thedirectory of Ross procedure surgeonsto locate a Ross procedure surgeon in your area.
Your Ross procedure recovery will vary based on your surgical outcomes and other factors such as your age and general health. Your surgeon will provide instructions and guidelines specific to your condition and recovery plan.
It is common to spend the first two to three days after surgery in a CCU. You will likely stay an additional few days in a medical/surgical unit for a total of about five to seven days or more in the hospital after your surgery.
Short-Term
Recovery from the Ross procedure can take four to eight weeks or longer, depending on your condition. Your breastbone usually heals in about six to eight weeks, but it may take two to three months for you to regain your normal strength and feel like yourself.
Before you leave the hospital, your care team will provide detailed instructions regarding diet, wound care, and guidelines for resuming normal activities and routines.
A typical short-term care plan involves the following instructions:
Your surgeon may prescribe one or more of the following medications to help you remain healthy during your recovery and prevent complications:
Anticoagulants (blood thinners) are not typically prescribed after a Ross procedure. In some cases, aspirin may be prescribed.
Long-Term Care and Monitoring
Research indicates that the Ross procedure can be an excellent option for aortic valve replacement for certain patient populations. It provides superior long-term survival, with those treated having survival rates that match the normal population. It also promotes excellent blood flow and has the potential for growth when used in children, including neonates and infants.
Long-term care and monitoring after a Ross procedure typically involves the following:
New Mechanical Heart Valve Design Has Potential to Reduce Need for Blood Thinners
Summary
The Ross procedure is a treatment option to replace an impaired aortic valve. When the valve is damaged, it creates extra stress on your heart as it works harder to bring blood to the rest of your body. When a damaged aorta can’t be repaired, a new aortic valve can restore normal function.
The Ross procedure removes your damaged aortic valve and replaces it with your own pulmonary valve. Using your natural tissue provides a stable substitute without the risk of rejection. A pulmonary valve from a donor heart is used to replace your pulmonary valve.
The Ross procedure offers a unique aortic valve replacement choice. It provides those treated with a life expectancy close to people with healthy hearts. Other benefits include long-term valve life without the need for blood thinners.
Contact your healthcare provider or cardiologist to discuss whether the Ross procedure is right for you. They can help you find a trained Ross surgeon if you decide to pursue this treatment.
24 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Aetna.Selected aortic valve procedures: Ross pulmonary autograft and aortic valve-sparing re-implantation.Northwestern Medicine.The Ross Procedure: healing your heart with your own parts.Cleveland JD, Bansal N, Wells WJ, Wiggins LM, Kumar SR, Starnes VA.Ross procedure in neonates and infants: A valuable operation with defined limits.The Journal of Thoracic and Cardiovascular Surgery. 2023;165(1):262-272.e3. doi:10.1016/j.jtcvs.2022.04.015Columbia Heart Surgery.Guide to aortic repair and replacement.American Heart Association (AHA).Types of replacement heart valves.Yale Medicine.Aortic valve disease.MedlinePlus.Aortic valve surgery - open.Guy’s and St. Thomas' Specialist Care.Aortic valve replacement surgery success rate.Notenboom ML, Melina G, Veen KM, et al.Long-term clinical and echocardiographic outcomes following the Ross procedure: a post hoc analysis of a randomized clinical trial.JAMA Cardiol.2024;9(1):6–14. doi:10.1001/jamacardio.2023.4090Boix-Garibo R, Uzzaman MM, Bapat V.Review of minimally invasive aortic valve surgery,Interventional Cardiology Review 2015;10(3):144–8.doi:10.15420/icr.2015.10.03.144Zelis JM, van ’t Veer M, Houterman S, Pijls NHJ, Tonino PAL; Netherlands Heart Registration Transcatheter Heart valve Implantation Registration Committee.Survival and quality of life after transcatheter aortic valve implantation relative to the general population. Int J Cardiol Heart Vasc. 2020 May 22;28:100536. doi:10.1016/j.ijcha.2020.100536Corewell Health.Heart valve disease treatment.Mount Sinai.The Ross procedure.American Heart Association (AHA).Ross procedure.UWHealth.Restoring your lifestyle with innovative valve surgery.Romeo JLR, Papageorgiou G, Costa FFD da, et al.Long-term clinical and echocardiographic outcomes in young and middle-aged adults undergoing the Ross procedure.JAMA Cardiol. 2021;6(5):539-548. doi:10.1001/jamacardio.2020.7434UCSF Health.Treatments A-Z: Ross procedure.Mazine A, David TE, Rao V, et al.Long-term outcomes of the Ross procedure versus mechanical aortic valve replacement: propensity-matched cohort study.Circulation. 2016;134(8):576-585. doi:10.1161/CIRCULATIONAHA.116.022800Hage A, Hage F, Valdis M, Guo L, Chu MWA.The Ross procedure is the optimal solution for young adults with unrepairable aortic valve disease. Ann Cardiothorac Surg. 2021 Jul;10(4):454-462. doi:10.21037/acs-2021-rp-26NHS.Recovery: aortic valve replacement.St. Vincent’s Hospital Heart Health.After heart valve surgery.Galzerano D, Kholaif N, Al Amro B, Al Admawi M, Eltayeb A, Alshammari A, Di Salvo G, Al-Halees ZY.The Ross procedure: imaging, outcomes and future directions in aortic valve replacement.Journal of Clinical Medicine. 2024; 13(2):630. doi:10.3390/jcm13020630Utah Health University of Utah.Ross procedure (pulmonary autograft procedure).The American Heart Association (AHA).Life’s simple 7.
24 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Aetna.Selected aortic valve procedures: Ross pulmonary autograft and aortic valve-sparing re-implantation.Northwestern Medicine.The Ross Procedure: healing your heart with your own parts.Cleveland JD, Bansal N, Wells WJ, Wiggins LM, Kumar SR, Starnes VA.Ross procedure in neonates and infants: A valuable operation with defined limits.The Journal of Thoracic and Cardiovascular Surgery. 2023;165(1):262-272.e3. doi:10.1016/j.jtcvs.2022.04.015Columbia Heart Surgery.Guide to aortic repair and replacement.American Heart Association (AHA).Types of replacement heart valves.Yale Medicine.Aortic valve disease.MedlinePlus.Aortic valve surgery - open.Guy’s and St. Thomas' Specialist Care.Aortic valve replacement surgery success rate.Notenboom ML, Melina G, Veen KM, et al.Long-term clinical and echocardiographic outcomes following the Ross procedure: a post hoc analysis of a randomized clinical trial.JAMA Cardiol.2024;9(1):6–14. doi:10.1001/jamacardio.2023.4090Boix-Garibo R, Uzzaman MM, Bapat V.Review of minimally invasive aortic valve surgery,Interventional Cardiology Review 2015;10(3):144–8.doi:10.15420/icr.2015.10.03.144Zelis JM, van ’t Veer M, Houterman S, Pijls NHJ, Tonino PAL; Netherlands Heart Registration Transcatheter Heart valve Implantation Registration Committee.Survival and quality of life after transcatheter aortic valve implantation relative to the general population. Int J Cardiol Heart Vasc. 2020 May 22;28:100536. doi:10.1016/j.ijcha.2020.100536Corewell Health.Heart valve disease treatment.Mount Sinai.The Ross procedure.American Heart Association (AHA).Ross procedure.UWHealth.Restoring your lifestyle with innovative valve surgery.Romeo JLR, Papageorgiou G, Costa FFD da, et al.Long-term clinical and echocardiographic outcomes in young and middle-aged adults undergoing the Ross procedure.JAMA Cardiol. 2021;6(5):539-548. doi:10.1001/jamacardio.2020.7434UCSF Health.Treatments A-Z: Ross procedure.Mazine A, David TE, Rao V, et al.Long-term outcomes of the Ross procedure versus mechanical aortic valve replacement: propensity-matched cohort study.Circulation. 2016;134(8):576-585. doi:10.1161/CIRCULATIONAHA.116.022800Hage A, Hage F, Valdis M, Guo L, Chu MWA.The Ross procedure is the optimal solution for young adults with unrepairable aortic valve disease. Ann Cardiothorac Surg. 2021 Jul;10(4):454-462. doi:10.21037/acs-2021-rp-26NHS.Recovery: aortic valve replacement.St. Vincent’s Hospital Heart Health.After heart valve surgery.Galzerano D, Kholaif N, Al Amro B, Al Admawi M, Eltayeb A, Alshammari A, Di Salvo G, Al-Halees ZY.The Ross procedure: imaging, outcomes and future directions in aortic valve replacement.Journal of Clinical Medicine. 2024; 13(2):630. doi:10.3390/jcm13020630Utah Health University of Utah.Ross procedure (pulmonary autograft procedure).The American Heart Association (AHA).Life’s simple 7.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Aetna.Selected aortic valve procedures: Ross pulmonary autograft and aortic valve-sparing re-implantation.Northwestern Medicine.The Ross Procedure: healing your heart with your own parts.Cleveland JD, Bansal N, Wells WJ, Wiggins LM, Kumar SR, Starnes VA.Ross procedure in neonates and infants: A valuable operation with defined limits.The Journal of Thoracic and Cardiovascular Surgery. 2023;165(1):262-272.e3. doi:10.1016/j.jtcvs.2022.04.015Columbia Heart Surgery.Guide to aortic repair and replacement.American Heart Association (AHA).Types of replacement heart valves.Yale Medicine.Aortic valve disease.MedlinePlus.Aortic valve surgery - open.Guy’s and St. Thomas' Specialist Care.Aortic valve replacement surgery success rate.Notenboom ML, Melina G, Veen KM, et al.Long-term clinical and echocardiographic outcomes following the Ross procedure: a post hoc analysis of a randomized clinical trial.JAMA Cardiol.2024;9(1):6–14. doi:10.1001/jamacardio.2023.4090Boix-Garibo R, Uzzaman MM, Bapat V.Review of minimally invasive aortic valve surgery,Interventional Cardiology Review 2015;10(3):144–8.doi:10.15420/icr.2015.10.03.144Zelis JM, van ’t Veer M, Houterman S, Pijls NHJ, Tonino PAL; Netherlands Heart Registration Transcatheter Heart valve Implantation Registration Committee.Survival and quality of life after transcatheter aortic valve implantation relative to the general population. Int J Cardiol Heart Vasc. 2020 May 22;28:100536. doi:10.1016/j.ijcha.2020.100536Corewell Health.Heart valve disease treatment.Mount Sinai.The Ross procedure.American Heart Association (AHA).Ross procedure.UWHealth.Restoring your lifestyle with innovative valve surgery.Romeo JLR, Papageorgiou G, Costa FFD da, et al.Long-term clinical and echocardiographic outcomes in young and middle-aged adults undergoing the Ross procedure.JAMA Cardiol. 2021;6(5):539-548. doi:10.1001/jamacardio.2020.7434UCSF Health.Treatments A-Z: Ross procedure.Mazine A, David TE, Rao V, et al.Long-term outcomes of the Ross procedure versus mechanical aortic valve replacement: propensity-matched cohort study.Circulation. 2016;134(8):576-585. doi:10.1161/CIRCULATIONAHA.116.022800Hage A, Hage F, Valdis M, Guo L, Chu MWA.The Ross procedure is the optimal solution for young adults with unrepairable aortic valve disease. Ann Cardiothorac Surg. 2021 Jul;10(4):454-462. doi:10.21037/acs-2021-rp-26NHS.Recovery: aortic valve replacement.St. Vincent’s Hospital Heart Health.After heart valve surgery.Galzerano D, Kholaif N, Al Amro B, Al Admawi M, Eltayeb A, Alshammari A, Di Salvo G, Al-Halees ZY.The Ross procedure: imaging, outcomes and future directions in aortic valve replacement.Journal of Clinical Medicine. 2024; 13(2):630. doi:10.3390/jcm13020630Utah Health University of Utah.Ross procedure (pulmonary autograft procedure).The American Heart Association (AHA).Life’s simple 7.
Aetna.Selected aortic valve procedures: Ross pulmonary autograft and aortic valve-sparing re-implantation.
Northwestern Medicine.The Ross Procedure: healing your heart with your own parts.
Cleveland JD, Bansal N, Wells WJ, Wiggins LM, Kumar SR, Starnes VA.Ross procedure in neonates and infants: A valuable operation with defined limits.The Journal of Thoracic and Cardiovascular Surgery. 2023;165(1):262-272.e3. doi:10.1016/j.jtcvs.2022.04.015
Columbia Heart Surgery.Guide to aortic repair and replacement.
American Heart Association (AHA).Types of replacement heart valves.
Yale Medicine.Aortic valve disease.
MedlinePlus.Aortic valve surgery - open.
Guy’s and St. Thomas' Specialist Care.Aortic valve replacement surgery success rate.
Notenboom ML, Melina G, Veen KM, et al.Long-term clinical and echocardiographic outcomes following the Ross procedure: a post hoc analysis of a randomized clinical trial.JAMA Cardiol.2024;9(1):6–14. doi:10.1001/jamacardio.2023.4090
Boix-Garibo R, Uzzaman MM, Bapat V.Review of minimally invasive aortic valve surgery,Interventional Cardiology Review 2015;10(3):144–8.doi:10.15420/icr.2015.10.03.144
Zelis JM, van ’t Veer M, Houterman S, Pijls NHJ, Tonino PAL; Netherlands Heart Registration Transcatheter Heart valve Implantation Registration Committee.Survival and quality of life after transcatheter aortic valve implantation relative to the general population. Int J Cardiol Heart Vasc. 2020 May 22;28:100536. doi:10.1016/j.ijcha.2020.100536
Corewell Health.Heart valve disease treatment.
Mount Sinai.The Ross procedure.
American Heart Association (AHA).Ross procedure.
UWHealth.Restoring your lifestyle with innovative valve surgery.
Romeo JLR, Papageorgiou G, Costa FFD da, et al.Long-term clinical and echocardiographic outcomes in young and middle-aged adults undergoing the Ross procedure.JAMA Cardiol. 2021;6(5):539-548. doi:10.1001/jamacardio.2020.7434
UCSF Health.Treatments A-Z: Ross procedure.
Mazine A, David TE, Rao V, et al.Long-term outcomes of the Ross procedure versus mechanical aortic valve replacement: propensity-matched cohort study.Circulation. 2016;134(8):576-585. doi:10.1161/CIRCULATIONAHA.116.022800
Hage A, Hage F, Valdis M, Guo L, Chu MWA.The Ross procedure is the optimal solution for young adults with unrepairable aortic valve disease. Ann Cardiothorac Surg. 2021 Jul;10(4):454-462. doi:10.21037/acs-2021-rp-26
NHS.Recovery: aortic valve replacement.
St. Vincent’s Hospital Heart Health.After heart valve surgery.
Galzerano D, Kholaif N, Al Amro B, Al Admawi M, Eltayeb A, Alshammari A, Di Salvo G, Al-Halees ZY.The Ross procedure: imaging, outcomes and future directions in aortic valve replacement.Journal of Clinical Medicine. 2024; 13(2):630. doi:10.3390/jcm13020630
Utah Health University of Utah.Ross procedure (pulmonary autograft procedure).
The American Heart Association (AHA).Life’s simple 7.
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