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Ross Procedure (also called Switch Procedure)
The Ross procedure is usually performed on patients younger than ages 40 to 50 who want to avoid taking long-term anticoagulant medications after surgery. During this procedure, the patient's own pulmonary valve is removed and used to replace the diseased aortic valve. The pulmonary valve is then replaced with a pulmonary homograft.
The Ross Procedure |
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| Step 1: Measurement of the aortic and pulmonic valves | Step 2: The aorta and pulmonary artery are opened and the aortic and pulmonary valves are carefully inspected to determine if the Ross is an appropriate procedure. |
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| Step 3: The diseased aortic valve is removed. Then, the pulmonary valve (autograft) is removed and placed in the aortic position. | Step 4: The autograft in sutured in place and the coronary arteries are re-attached. |
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| Step 5: A pulmonary homograft is attached to the right ventricle outflow tract. | Step 6: The aorta is attached to the autograft and the pulmonary artery is attached to the homograft - the procedure is complete. |
The Ross operation is not performed when operative findings contraindicate the procedure, or when the pulmonary valve does not appear normal on the echocardiogram, or on inspection during surgery.
Advantages: The pulmonic valve is anatomically very similar to the aortic valve and could be an ideal substitute for the aortic valve. The new aortic autograft is a living valve and it will grow as the young adult grows, making this a good option for young patients. The blood flows with less pressure through the pulmonary valve than the aortic valve, therefore a homograft valve could last longer in the right-sided pulmonary valve position. The risk of thromboembolic complications (blood clots, stroke) and the risk of valve infection are very low -- lower than for any alternative valve prosthesis. The hemodynamic performance makes the Ross operation an attractive alternative for athletes. The pulmonary autograft valve has a good chance* of being a life-lasting solution for the aortic valve.
*Our qualified guess is that the pulmonary autograft will last a lifetime in at least half of Ross procedure patients.
Drawbacks: The Ross procedure is a technically difficult and long surgery, as it requires two valve replacements. Therefore, this procedure is only recommended for young patients who would tolerate a long surgery time. The pulmonary autograft valve is transplanted from the low pressure pulmonary circulation over to the aortic high pressure system. The valve cusps are strong enough to withstand the systemic pressure, but the pulmonary artery wall does dilate when exposed to systemic pressure, occasionally enough to cause the autograft valve to leak. The risk of requiring re-operation for a leaking autograft valve is about 10 percent within 10 years after the operation. The Ross procedure is not recommended for patients with tissue defects (such as Marfan syndrome) or for patients who have an abnormal pulmonary valve. The pulmonary homograft in the pulmonary position could also fail; the most common reason for failure is that it becomes stenotic. The risk of requiring replacement of the pulmonary homograft is about 10 percent within 10 years after the procedure.
The Ross procedure should only be performed by very skilled and experienced surgeons.
Click here for more information on options for aortic valve surgery in the young adult patient.
If you have questions or need more information:
To obtain a surgical consultation, or if you have additional questions or need more information, you may contact us by email, using the Contact Us Form.
You may also call the Heart & Vascular Institute Resource Nurse at 216/445-9288 or toll-free 866/289-6911. Webmail and phone calls are answered between 8:30 am to 4:00 pm on regular business days.
© Copyright 2007 The Cleveland Clinic Foundation. All rights reserved
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