Ross procedure

What is it?

The Ross procedure is an open-heart surgery in which the aortic valve is replaced with the patient's own pulmonary artery and the pulmonary artery is replaced with a lung homograft from a deceased donor.

Technical difficulty:
very high (it is considered one of the most complicated operations)
Average duration of the intervention:
6 hours
Average duration of hospitalization:
12 days

When is this procedure indicated?

The operation is particularly indicated in aortic valve pathologies (aortic stenosis; aortic insufficiency) especially in newborns and young children. Other patients who can benefit from the Ross procedure are patients who have a contraindication to the mechanical prosthesis, young women who have to give birth, patients undergoing multiple aortic valve replacements and in cases of endocarditis on a prosthesis or on a native aortic valve.

How is it performed?

The surgery is conducted under extracorporeal circulation and involves operating on the open heart. Surgeons begin by cannulating the inferior vena cava and aorta, initiating extracorporeal circulation while examining the pulmonary artery for proper anatomy. After clamping the aorta and administering cardioplegia to stop the heart, they open the aorta to assess the aortic valve for repair. If repair isn't viable, the valve is removed, and the coronary arteries are detached from the aortic wall. Samples are then taken from the pulmonary artery before its branches bifurcate. The prepared pulmonary autograft is reimplanted as the new aorta, followed by reimplantation of the coronary arteries. Reconstruction of the right ventricular outflow tract involves implanting a pulmonary homograft from a deceased donor. Once the aorta is unclamped and extracorporeal circulation ceases, four temporary epicardial electrodes are implanted.


After discharge, a period of home convalescence of 3/4 weeks is necessary before resuming usual activities. As a rule, after 2-3 months you can stop all therapy and resume sports activity.

Short-term complications

Short-term complications may include: post-operative bleeding, electrocardiographic changes which may require implantation of a permanent pacemaker. Like all heart operations, infections of the sternal wound are possible with the appearance of mediastinitis in some cases.

Long-term complications

In our Center, 370 Ross operations were performed with a mortality of 0.2%. Long-term complications are mainly the following:

  • appearance of aortic valve insufficiency;
  • aneurysmal dilatation of the new aorta;
  • stenosis or failure of the pulmonary homograft;
  • possible endocarditis on the homograft.

All 4 complications may in the long term require a new aortic valve replacement, or pulmonary homograft, or dilated new aorta.


Page edited by: Alessandro Frigiola

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