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Ross procedure
From Wikipedia, the free encyclopedia
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.[1]
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The Ross procedure is named after Dr. Donald Ross - a pioneer in cardiac surgery in the UK - who proposed the procedure in 1962[2] and first performed it in 1967.
- 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.
- Single valve disease (aortic) becomes two valve disease (aortic and pulmonary).
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.[3]
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.[3]
- ^ Yacoub M, Klieverik L, Melina G, Edwards S, Sarathchandra P, Bogers A, Squarcia U, Sani G, van Herwerden L, Takkenberg J (2006). "An evaluation of the Ross operation in adults". J Heart Valve Dis 15 (4): 531-9. PMID 16901050.
- ^ Ross D (1962). "Homograft replacement of the aortic valve". Lancet 2: 487. PMID 14494158.
- ^ a b Chambers J, Somerville J, Stone S, Ross D (1997). "Pulmonary autograft procedure for aortic valve disease: long-term results of the pioneer series". Circulation 96 (7): 2206-14. PMID 9337191.
- Cardiac Surgery in the Adult - Pulmonary autograft
Surgeries/Surgical diseases of the aorta
Aortic aneurysm, Aortic dissection, Bentall procedure, David procedure, Marfan syndrome
Valvular Heart Disease
Aortic valve repair, Aortic valve replacement, Ross procedure, Mitral valve repair, Mitral valve replacement, Tricuspid valve repair, Tricuspid valve replacement
Surgeries/Surgical diseases of the myocardium
Coronary artery bypass surgery, Ischemic VSD, Maze procedure, Septal myectomy, Ventricular reduction
Heart transplantation
Ischemic cardiomyopathy, Hypertrophic cardiomyopathy, Ventricular assist device
Congenital heart disease
Atrial septal defect, Ebstein's anomaly, Pulmonary stenosis, Tetralogy of Fallot, Transposition of the great arteries, Ventricular septal defect
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