The Ross Procedure is an exciting surgical alternative for people with aortic valve disease. Dr. Paul Stelzer is one of only a handful of surgeons worldwide who have performed over 400 of these complex procedures. Dr. Stelzer is a professor of cardiothoracic surgery and co-director of the Heart Valve Center at The Mount Sinai Hospital in New York City.
The Ross Procedure, also known as the pulmonary autograft procedure for aortic valve disease, was developed by the British surgeon Donald Ross in 1967. Unlike other cardiac operations that use a mechanical valve or a tissue valve taken from an animal, the Ross Procedure replaces a patient’s damaged aortic valve with his or her own pulmonic valve. This has the distinct advantage of being a totally living human valve. It’s flow characteristics are better than any artificial valve and it will never damage blood cells or cause clotting so no blood thinners are necessary.
Substituting the patient’s own pulmonary valve for the aortic valve is the only replacement valve that is truly alive and potentially able to last a normal lifetime without blood thinners or further surgery.
The pulmonary valve has the same embryological origin although its structure under the microscope is slightly different from the aortic valve. The pulmonary valve normally faces much lower pressures than the aortic valve, but under test conditions, the pulmonary valve has proven reliable at aortic pressures. The pulmonary autograft has been shown to grow with the rest of the body in young children. No other valve substitute can do this.
The biggest drawback is that the operation is longer and more demanding of a surgeon’s skill and concentration, with a higher risk of bleeding. The other intrinsically limiting factor becomes the replacement valve in the pulmonary position. Here, the homograft (donor human valve) has proven itself to be a durable substitute, significantly better than in the aortic position, regardless of how it is preserved. Practically speaking, cryo-preservation is the most common method used to make these precious resources available.