Ross procedure for Aortic Valve Repair

The Ross procedure is used to replace a defective aortic valve. The aortic valve has an important job: Handling all of the blood that the heart pumps out to the body. When this one-way valve works properly, it prevents backwashing of blood back into the heart as the heart pumps red blood from the left ventricle to the aorta. But some children with congenital heart disease are born with defective aortic valves. The Ross procedure is an innovative technique that uses a patient’s own pulmonary valve to replace a damaged aortic valve. The new valve grows with the child, making the Ross procedure the aortic valve replacement technique of choice for small children and infants.

What are the steps in the Ross procedure?

This technique, sometimes known as the Ross-Yacoub procedure after the doctors who pioneered it, has been successfully used since 1967. In this procedure, your child’s aortic valve is removed. Next, the healthy pulmonary valve (known as an autograft valve because it comes from living tissue in the child’s own body) is removed and sewn in the place of the aortic valve. A pulmonary valve from a donated organ is then used to replace the child’s original pulmonary valve (known as a homograft valve because it comes from another human).

Because the aortic valve is typically the harder-working valve, it’s better to use the child’s own tissue to repair the aortic valve, which is why the child’s pulmonary valve is used for replacement. Once the new aortic valve is in place, it works very effectively for blood pumped by the heart to the rest of the body, just as it should normally.

The Ross procedure is a more extensive surgery than a traditional mechanical aortic valve replacement. The Ross procedure is also not a “forever” solution: The donated pulmonary valve often needs to be replaced later in life.

Experts in the Ross procedure

This is a complex procedure that should only be done by a surgeon experienced with this advanced approach to aortic valve replacement. The Herma Heart Institute is one of the nation’s top pediatric heart programs and consistently delivers some of the best congenital heart surgery outcomes for even the most complex types of heart disease. If your child has already been diagnosed with aortic valve problems at another center, we invite you to get a second opinion at the Herma Heart Institute.

We’re proud of our history of innovation that has changed the practice of heart surgery worldwide. The Herma Heart Institute is also home to a leading Adult Congenital Heart Disease Program, allowing for seamless, high quality care across your child’s lifespan.

Who needs a Ross procedure?

This procedure is used to treat children with defective or failing aortic valves. Children might have aortic stenosis, when a valve doesn’t open enough, or aortic regurgitation, when a valve opens too much and lets blood leak back into the left ventricle. If untreated, children with defective aortic valves are at risk of congestive heart failure or sudden cardiac death. A Ross procedure is not always required to repair aortic valve disease. Your child’s doctor will advise you on the best options for your child.

What to expect during a Ross procedure

The Ross procedure surgery takes several hours while your child is under general anesthesia in the operating room. The surgeon will make an incision in your child’s chest and open the breast bone to access the heart. During the surgery, your child will be connected to a heart-lung machine that does the work of the heart and lungs. The surgeon will remove your child’s pulmonary valve and aortic valve and then attach the pulmonary valve in place of the old aortic valve. The donor valve will then be attached in place of your child’s original pulmonary valve. When the repairs are complete, your child will be taken off the heart-lung machine, and the surgeon will close up your child’s chest.

After surgery, your child will spend time in the cardiac intensive care unit (CICU). During the first several hours after the procedure, your child will likely be drowsy from the anesthesia and medications given to ease anxiety and pain. Over time, your child will become more alert.
While your child is in the CICU, Children’s might use the following equipment:

  • Ventilator - This machine helps your child breathe. A small, plastic tube is guided into the windpipe and attached to the ventilator, which breathes for your child while they are under anesthesia. Many children have the ventilator tube removed right after surgery, but some will benefit from remaining on the ventilator for a few hours afterward so they can rest.
  • Intravenous (IV) catheters - These small, plastic tubes inserted into blood vessels provide IV fluids and important medications that help your child recover from the operation.
  • Pacer wires - Small wires are connected to your child’s heart through the chest wall placed at the time of surgery to allow use of a temporary pacemaker. The wires are removed at the bedside when they are no longer needed.
  • Arterial line - A specialized IV placed in the wrist, or other area of the body where a pulse can be felt, measures blood pressure continuously during surgery and while your child is in the ICU.
  • Nasogastric (NG) tube - A small, flexible tube keeps the stomach drained of acid and gas bubbles that could build up during surgery.
  • Urinary catheter - This small, flexible tube drains urine out of the bladder and accurately measures how much urine the body makes, which helps determine how well the heart is functioning. Some swelling and puffiness is common after surgery, and your child might be given diuretics to help the kidneys remove excess fluids.
  • Chest tube - A drainage tube might be inserted to keep the chest free of blood that would otherwise accumulate after the incision is closed. Bleeding can occur for several hours or even a few days after surgery.
  • Heart monitor - This machine constantly displays a picture of your child’s heart rhythm and monitors heart rate, arterial blood pressure and other values.

Your child might need other supportive equipment while in the CICU or afterward. They will be kept as comfortable as possible with medications that relieve pain and anxiety, and the staff might also ask for your input on how best to soothe and comfort your child.
Your child will need to stay in the hospital 7-10 days to recover after a Ross procedure. After your child is discharged from the CICU, they will recuperate on another hospital unit for a few days before going home. You will learn how to care for your child at home and will receive instructions on medications, activity limitations and follow-up appointments before your child is sent home.

Care for your child at home following a Ross procedure

Most children feel fairly comfortable when they go home, and your physician might recommend pain medications, such as acetaminophen or ibuprofen, to keep them comfortable. Your child might become tired more quickly than before surgery, but they usually will be allowed to play with supervision. It’s important to avoid blows to the chest that might cause injury to the incision or breastbone. Within a few weeks, your child should be fully recovered and able to participate in normal activity.

Long-term outlook and recovery after a Ross procedure

Ross procedure outcomes are generally very good. Children go on to lead healthy, normal lives and do not require the blood-thinning medications that are typically required with mechanical valve replacements. Some children might eventually need another valve replacement surgery if one of the replacement valves develops a problem, but it might be many years before another surgery is needed. Your child will always need to be monitored by a cardiologist in case new problems develop, and once they reach adulthood, they should seek out a program that specializes in adult congenital heart disease like Children’s ACHD program.