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The Ross Procedure, also known as the pulmonary autograft procedure for aortic valve disease, is a special surgical technique used to replace a diseased aortic valve. The Ross Procedure was developed by British surgeon Dr. Donald Ross in 1967, and is designed for people who have significant aortic valve disease–either stenosis, or regurgitation or both. In the advanced stages, aortic valve disease can cause chest pain (angina), syncope (fainting), shortness of breath, rhythm disorders or congestive heart failure.
Unlike other heart valve replacement operations that use a mechanical valve or a tissue valve taken from an animal, the Ross Procedure replaces a patient’s damaged aortic valve with his or her own pulmonary valve. The pulmonary valve is used because it is the patient’s own tissue and is identical in shape, size and strength to the aortic valve. The pulmonary valve is in turn replaced by a human donor valve. A patient's own pulmonary valve has a unique durability in the aortic valve position, which minimizes the need for future valve re-replacement which is a great advantage over traditional bioprosthetic (animal tissue) valves.
The major advantage of using tissue valves during valve replacement instead of mechanical valves is that lifetime blood thinning medication is not required, allowing patients to lead active lives without the many risks associated with blood-thinner use.
Overall, the success rate for the Ross Procedure is over 97 percent and the long-term results have been excellent with more than 80 percent of patients alive after 20 years and fewer than 15 percent needing further valve procedures. Generally, valve replacement is recommended when there are signs and symptoms of a progressive strain on the left ventricle, the main pumping chamber of the heart. The left ventricle may become dilated and the wall thickened with extra muscle (hypertrophy). Symptoms may include palpitations ("heart pounding"), reduced exercise tolerance and/or episodes of severe shortness of breath. In some patients, fainting, especially following exercise, may occur.
A variety of conditions may eventually lead to an abnormal aortic valve which requires replacement. A congenital condition, known as bicuspid aortic valve (the aortic valve normally has three leaflets), may over several decades lead to progressive leakage or serious obstruction. Rheumatic fever may cause damage to the aortic valve. In certain families, a genetic trait causes weakness of the aortic valve and the wall of the aorta, producing a progressive leakage. In some older patients, the valve leaflets gradually become stiffened due to fibrosis or calcification and produce an obstructive condition known as senile aortic stenosis.
The Ross Procedure works best on patients who have a 25 year life expectancy, are not suffering from any other major illnesses and have good heart function. While the majority of patients are male, the procedure is especially suited to women of childbearing years because they do not have to take blood-thinning medication (warfarin or Coumadin)–known to cause birth defects–to prevent thromboembolism (clot formation leading to stroke or other tragic consequences) from a mechanical valve.
While there are about 200 surgeons capable of performing this procedure worldwide, less than a handful practice in the New York metropolitan area. Dr. Charles M. Geller of the Cardiac Surgery Division at Mount Sinai Beth Israel is one of these physicians. He has over 10 years of experience performing the Ross Procedure, and has helped contribute to some of its more recent modifications. The Beth Israel Ross Procedure experience has been published in the surgical literature including the Journal of Thoracic and Cardiovascular Surgery.
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