Ross Procedure for Aortic Valve Replacement in Young Adults: Preferred Procedure or "Double, Double Toil and Trouble"?

Abstract

Since the original description of aortic valve replacement (AVR) with a pulmonary autograft by Donald Ross in 1967, 1 cardiac surgeons have had an uneasy relationship with this method for managing aortic valve disease. In many patients, the implanted autograft functions normally with no evidence of late deterioration, and thus is an ideal valve substitute. The Ross procedure has a special advantage in young children, because the implanted autograft can enlarge with somatic growth. 2 However, the operation is more complicated than standard prosthetic AVR because of the need for careful dissection during harvest of the pulmonary artery graft, the requirement for precise alignment of the graft within the aortic root, and the added potential for late dysfunction of the homograft or heterograft used to replace the native pulmonary valve.