Clinical aspects of the Ross procedure: indications and contraindications

In the past decade, the pulmonary autograft procedure has emerged as the operation of choice for young individuals with aortic root pathology not amenable to repair. This is due in large part to the durability of the pulmonary autograft in the aortic position. Freedom from thrombosis and long-term anticoagulation also provide support for its application, as well as the pulmonary autograft's similarity to the human aortic valve. The present indications for the Ross procedure continue to broaden. Patient age is certainly a factor, with the upper limit being 50 years. Patients who present with mechanical or bioprosthetic aortic valve dysfunction also seem to be appropriate candidates for the procedure, as do those who present with active endocarditis. Athletes also are an appropriate subset based on the absence of anticoagulation and the extreme physiological and hemodynamic consequences of their chosen field. Contraindications to the Ross procedure include multivessel coronary artery disease as well as multiple pathology in which a second valve replacement device is required. Extremes of age and severely depressed left ventricular function also contradict application of the pulmonary autograft.