Ross Procedure

Overview

The Ross procedure is a surgical treatment for aortic valve disease in which the patient’s own pulmonary valve is used to replace an unhealthy aortic valve. This aortic valve replacement technique is sometimes referred to as a pulmonary autograft procedure.

There are two important steps in the surgical process. Initially, the patient’s own pulmonary valve is used to replace an unhealthy aortic valve. A healthy donor valve is then placed in the area where the pulmonary valve formerly was.

Aortic valve function is vital to overall health. It opens to allow blood rich in oxygen to leave the heart out to the body and to prevent blood from returning to the heart between heartbeats. Aortic valve disease, including stenosis (narrowing) and regurgitation (leaking), can impair valve function and cause sickness. These problems increase the likelihood of serious consequences like infections and heart failure.

Reasons for undergoing the procedure

Patients with congenital aortic stenosis, narrowed aortic valve at birth, aortic valve endocarditis, or other types of aortic valve disease who are younger than 60 years of age may benefit from a Ross surgery.

In the Ross procedure, the aortic valve is repaired using a functional pulmonary valve. This method is not common but effective because:

• The aortic valve experiences elevated pressure. Long-term valve health is ensured with a sturdy replacement. Prosthetic valves are more vulnerable to blood clots and early deterioration. These hazards can be avoided with natural tissue replacements.
• The pulmonary valve is not subjected to high pressure. It resembles the aortic valve in both size and shape. The position of the pulmonary valve is more accommodating to the degeneration of a donor valve.

In severe heart valve disease, the non-functioning valve must be replaced. Utilizing one’s own tissue maximizes the long-term functionality of the valve.

Following a successful Ross procedure, patients’ quality of life is comparable to that of individuals without heart disease. Exercise is not restricted in any way. They also have a far lower chance of developing heart failure.

Risk

Several risks are associated with this complex procedure. The risk of problems is reduced when the patient receive care from a heart surgeon with extensive expertise doing Ross procedures.

Risks of the Ross procedure could include:

• Aortic autograft dilation, or abnormal enlargement of the aorta around the replacement valve.
• Pulmonary allograft stenosis or narrowing of the new aortic valve.
• Arrhythmia or abnormal heart beat.
• Heart attack.
• Infection
• Hemorrhage
• Heart valve leak

Before the procedure

• Undergo a thorough medical evaluation.
• Discuss the procedure, risks, and outcomes with the surgeon.
• Complete necessary diagnostic tests.
• Adjust or start medications as advised.
• Ensure good dental health.
• Consider lifestyle changes like quitting smoking and adopting a heart-healthy diet.
• Make logistical arrangements for transportation and assistance during recovery.

Specific preparations may vary based on individual health conditions and medical advice.

During the procedure

It takes many hours to finish the Ross proceudre. This is what transpires:

• General anesthesia, which induces sleep and momentarily impairs sensation, will be administered to the patient. They won’t remember the procedure.
• The patient is placed on a heart-lung (cardiopulmonary) bypass machine by the healthcare provider. This enables their heart to be stopped safely. During the procedure, cardiopulmonary bypass replaces the patient’s heart and lungs.
• In order to access the pulmonary and aortic valves, a healthcare provider must first make a sternotomy, or cut through the breastbone.
• They check the pulmonary valve to make sure it is in good enough condition to take the place of the aortic valve.
• The pulmonary valve is substituted for the injured aortic valve by the healthcare provider. A functional donor pulmonary valve is then implanted.
• The heart-lung bypass equipment is gradually removed by the surgeons after the replacement valves are in place.
• They perform tests to make sure the pulmonary and aortic valves are functioning correctly.
• Surgeons reposition their breastbone and fasten it with wires to finish the operation.
• They use surgical dressings that safeguard the area and sutures to close incisions.

After the procedure

Following surgery, the patient will wake up in the cardiac intensive care unit (ICU). For breathing assistance, they could require a ventilator. Real-time evaluations of heart function are possible using a heart monitor. The ICU stay for a patient may last up to five days.

For several months, the recovery process continues at home. Throughout this period, it’s typical to encounter such as constipation, depression, insomnia, loss of appetite, or numbness and swelling at the incision site.

Following a Ross procedure, ongoing monitoring is essential to assess the performance of the valve. The replacement pulmonary valve is not designed for a lifetime and typically requires replacement every 15 to 20 years. Regular surveillance ensures that you receive a timely replacement when needed. Healthcare professionals frequently employ minimally invasive methods for this operation, resulting in a swift and smooth recovery process.

Outcome

A number of benefits of this technique include:

• The capacity to lead an active lifestyle, which includes driving and frequent exercise.
• The capacity to conceive safely for women.
• The body’s excellent blood flow.
• There’s no need for the lifelong blood thinners that come with conventional treatments.
• After surgery, many patients report feeling better immediately following the procedure.

If the patient exhibits any of the following symptoms, seek medical attention:

• Chest pain
• Coughing up blood
• Fever or chills
• Red stool (indication of bleeding)
• Lightheadedness or dizziness
• Tingling sensation at the hand or feet
• Unexplained bruising.
• Vomiting