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Ross Procedure for AVR

What is the Ross Procedure (or pulmonary autograft for aortic valve replacement)?

The Ross Procedure is the preferred method for aortic valve replacement in children and young adults. It provides the potential for growth in children and does not require the use of blood thinners, a major disadvantage of artificial valves.

Preparing for the procedure

Prior to cardiac surgery, this heart defect will be diagnosed with an EKG, a chest x-ray and an echocardiogram. Before surgery, blood tests are conducted to be sure that there is no infection and no problem with clotting, and that normal electrolyte levels are in the blood. A blood test to determine the blood type and compatibility will be performed so that blood will be available for the surgery.

During the procedure

During this procedure, the child will be placed under general anesthesia and special monitoring IVs will be used. The chest is opened through the sternum (breastbone). The heart/lung machine is connected. Once the heart is stopped and emptied, the aorta and the pulmonary artery are divided. The patient's pulmonary artery and pulmonary valve are removed and relocated to replace the defective aortic valve. The pulmonary valve is then replaced with a pulmonary allograft (also known as a homograft). This is a human cadaver valve harvested shortly after death, sterilized and preserved in deep freeze. The allograft functions better in the pulmonary position than it does in the aortic position because of the lower pressure that it is subjected to. Furthermore, it is much easier to replace the pulmonary valve later in life if necessary than it would be to replace the aortic valve. The long-term results with this procedure, published from multiple centers in the United States and Europe, have been encouraging. At the Inova Heart Center, cardiac surgeons have been performing the Ross Procedure since August 1996 with excellent results.

After the procedure

After surgery, the child will need a number of days to recover from anesthesia, from the use of heart-lung bypass equipment and from the surgery. Initially, the child will be on a ventilator (breathing machine) and may need support from intravenous medicines and a temporary pacemaker. Once the breathing tube (endotracheal tube) is out, the main goals are to return to normal activity and to normal eating and to gain weight.

Click here for recovery guidelines after discharge for congenital heart defect repair at the Inova Heart Center.