Ross Procedure: How to Do It and How to Teach It

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Pediatric Cardiac Surgery

Background:

• Aortic valve replacement (AVR) in children faces challenges with small prosthesis sizes, lack of growth, and anticoagulation risks.
• The Ross procedure, utilizing a pulmonary valve autograft, presents advantages for pediatric and adult AVR.
• Standard AVR prostheses may not be suitable for all pediatric patients due to size and growth limitations.

Purpose of the Study:

• To describe the surgical technique for the Ross procedure including ascending aorta replacement.
• To present a case of Ross AVR in an adult with a bicuspid aortic valve, stenosis, insufficiency, and aortic dilation.
• To highlight the benefits of the Ross procedure in specific patient populations.

Main Methods:

• Detailed description of the current Ross AVR technique, incorporating ascending aorta replacement with a prosthetic graft.
• Video documentation of the procedure performed on an adult male patient.
• Surgical management of a bicuspid aortic valve with mixed stenosis and insufficiency and a dilated ascending aorta.

Main Results:

• The Ross procedure was successfully performed, addressing aortic valve pathology and aortic dilation.
• The technique allows for the use of a living autograft, potentially accommodating growth and reducing long-term complications.
• Avoidance of mechanical prosthetic valves eliminates the need for long-term anticoagulation.

Conclusions:

• The Ross procedure is a viable and advantageous option for aortic valve replacement, particularly in younger patients and those with specific aortic pathologies.
• This technique effectively manages complex aortic valve disease and ascending aorta issues.
• The use of a pulmonary autograft in the Ross procedure offers a biological solution to AVR challenges.