The Ross procedure in adults: which patients, which disease?

Abstract

The purpose of this article is to review the contemporary evidence surrounding the use of the Ross procedure in young and middle-aged adults and to identify the subset patients who are most likely to derive a benefit from this operation. In appropriately selected young and middle-aged adults undergoing aortic valve replacement (AVR), the Ross procedure is currently the only operation that can restore long-term survival that is equivalent to that of the age-matched healthy general population. The ideal patient for the Ross procedure is a young, otherwise healthy adult with aortic stenosis and a small or normal size aortic annulus. In addition, this operation is particularly valuable in women contemplating pregnancy and patients with high level of physical activity, as well as those who wish to avoid the burden of lifelong anticoagulation. When carried out in expert centers with adequate surgical volumes, the Ross procedure is associated with superior long-term outcomes compared with prosthetic AVR, with minimal cost in terms of early morbidity and mortality. Despite the expanding body of evidence demonstrating its long-term superiority over conventional prosthetic AVR in appropriately selected patients, the Ross operation remains largely underused. This situation mandates careful reexamination of current practice guidelines.