Ross procedure

The Ross procedure (or pulmonary autograft) is a cardiac surgery operation where a diseased aortic valve is replaced with the person's own pulmonary valve. A pulmonary homograft (valve taken from a cadaver) is then used to replace the patient's own pulmonary valve. Pulmonary autograft replacement of the aortic valve is the operation of choice in infants and children, but its use in adults remains controversial.

History
The Ross procedure is named after Dr. Donald Ross - a pioneer in cardiac surgery in the UK - who proposed the procedure in 1962 and first performed it in 1967.

Advantages

 * Freedom from thromboembolism without the need for anticoagulation.
 * The valve grows as the patient grows (i.e. children).
 * Favourable hemodynamics.
 * No foreign material present in the valve.

Disadvantages

 * Single valve disease (aortic) treated with a two valve procedure (aortic and pulmonary).

Pulmonary valve replacement
One of the main objections to the Ross procedure is the genesis of pulmonary valve disease in addition to aortic valve disease. Protagonists have argued that biological valves implanted in the pulmonary position would be slow to develop dysfunction, and any dysfunction would be well tolerated due to the lower pressures in the right side of the heart. Survival of homografts in the pulmonary position is good (20-year freedom from reoperation of 80%), and homograft dysfunction is infrequently implicated in the observed morbidity and mortality.

Homografts (aortic or pulmonary) should be the replacement of choice; no other valve performed as well in the pulmonary position. Many homograft valves are sterilized with ethylene oxide or irradiation; methods recognized to have deleterious effects on valve performance. The results of the pulmonary autograft procedure are likely to be superior with the use of fresh homograft valves. Today, cryopreservation is the method of choice for homograft preservation.