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Valve Disease
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Described by Donald Ross in 1967, the Ross procedure involves replacing the patient's diseased aortic valve with their own pulmonary valve which is, in turn, replaced by a homograft. The procedure requires a double-valve replacement at operation with attendant increased surgical risk. The procedure is of particular value in children as the translocated pulmonary trunk grows with the child. This provide a haemodynamically superior and viable valve. However, late problems do develop, due to failure of the pulmonary homograft, often requiring replacement with prolonged survival after initial surgery or, more recently, valve in valve transcatheter insertion.
Cardiology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Transcatheter balloon valvuloplasty is preferred to open surgery in most units. This is not curative treatment and later in life aortic valve replacement may be required, often because of aortic regurgitation from the balloon procedure. The usual operation involves the Ross procedure rather than using a prosthetic valve. This involves replacement of the damaged aortic valve with the patient’s own pulmonary valve, and replacing the pulmonary valve with a homograft. This process allows growth of the valves and eliminates the need for anticoagulation.
Congenital cardiac anomalies
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
The Ross procedure is performed for aortic valve stenosis or insufficiency, whereby the patient’s own pulmonary valve and pulmonary artery are excised en masse, and placed in the aortic position, with reimplantation of the coronary arteries into the pulmonary autograft. A right ventricle-to-pulmonary artery conduit is then placed in the right ventricular outflow tract. A Ross procedure allows for the potential for growth with time, avoids anticoagulation and provides for better haemodynamics across the left ventricular outflow tract.
Future prospects in the tissue engineering of heart valves: a focus on the role of stem cells
Published in Expert Opinion on Biological Therapy, 2023
Benjamin J Albert, Jonathan T Butcher
Pediatric, adolescent, and young adult patients with severe HVD may require heart valve replacement to restore proper flow and mitigate the upstream burden on their heart [17,18]. Replacement of a dysfunctional aortic valve in a young patient may be done by replacing the aortic valve with the pulmonary valve (Ross procedure) or through surgical valve replacement [19]. The Ross procedure has shown effective performance in both young patients and adults but can be subject to dilatation and stenosis in children who are still growing [20,21]. Prosthetic valve replacement in growing patients also presents a hurdle because of the need for resizing surgeries as the patient outgrows prostheses. Tissue engineered heart valves (TEHV) may eventually be able to replace these techniques; the dysfunctional valve would be able to be replaced once and then the TEHV would grow with the patient [22].
Contemporary Review of the Ross Procedure
Published in Structural Heart, 2021
Vincent Chauvette, Laurence Lefebvre, Marie-Ève Chamberland, Elbert E. Williams, Ismail El-Hamamsy
The Ross procedure consists of replacing the aortic valve and root by the patient’s own pulmonary root, and reconstructing the pulmonary root with a pulmonary homograft, therefore placing a living autologous substitute in the aortic position.23 The rationale for the operation was based on the theory that a living substitute in the aortic position would result in near-normal hemodynamics and adaptive biology.23,24 Over the last decade, numerous studies have indicated that this effectively translates into improvements in late clinical outcomes.2–6,25–29 However, there are important caveats which also ought to be considered. In this section, we will present contemporary data on the Ross procedure, with a focus on long-term survival, hemodynamics, quality of life and reintervention.
Treatment strategies for mixed aortic valve disease in nonelderly patients
Published in Expert Review of Cardiovascular Therapy, 2019
Maria Von Stumm, J. Petersen, D. Westermann, Hermann Reichenspurner, Evaldas Girdauskas
Currently, the Ross procedure accounts for less than 0.5% of all aortic valve replacement procedures, which are registered by the STS National Database [54]. Considering the benefits of using the patient’s own living tissue over other suboptimal options for aortic valve replacement, these low numbers of Ross procedure worldwide are worrisome. The advantages of favorable hemodynamics, low thrombogenity, avoidance of anticoagulation, and low risk of endocarditis lead all together to excellent long-term survival rates [15,55]. This was recently demonstrated by the research group of Dr. Takkenberg, in a meta-analysis and microsimulation model. This meta-analysis included 99 studies (n = 13,129) on Ross procedure in children (mean age 9.4 years) and adults (mean age 41.9 years) with a pooled mean follow-up of 8 years [15]. In their pooled cohort, early mortality was 2% and late mortality was 0.6% per year in adults [15]. Calculated by a microsimulation model, the lifetime risk of autograft and right ventricular outflow tract reintervention for a 45-years-old patient were 49% and 19%, respectively. Estimated life expectancy after the Ross surgery for a 45-years-old adult was 30 years which was almost identical to the general population (i.e. life expectancy in the general population was 31 years) [15].