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Article

The Ross Procedure Restores Patients’ Life Expectancy

Autologous graft offers the best aortic valve replacement option

Jordan McCollum

Published

October 1, 2024

Pioneered almost 60 years ago, the Ross procedure treats patients with poor aortic valve function by moving the pulmonic valve into the aortic position and replacing the pulmonic valve with a preserved tissue graft. Although still a common operation, some centers eschew the surgery due to the level of expertise required and common misconceptions about outcomes, says Duke heart surgeon Ziv Beckerman, MD.

“The Ross operation was one of the first valve replacement surgeries,” says Beckerman. Despite its long history, not all centers are prepared to offer such an involved procedure. “You need an experienced surgeon who is comfortable operating on both the left and right sides of the heart,” Beckerman says. The technique has better outcomes at centers where it is routinely done. “If you look at centers that do the Ross operation more than 10 or 15 times a year, those have far less than 1% mortality.”

Misconceptions about the Ross procedure

Beckerman says one reason why the Ross operation is not used more is a number of persistent myths about the method and its outcomes. However, data show that these myths are misconceptions.

“Many believe that the Ross is riskier and recovery is longer, or it’s not durable, or it’s not for older patients,” says Beckerman. “Numerous long-term, large-scale patient series, as well as meta-analyses, show that the Ross is actually the only procedure that can restore long-term survival to match that of the general population.”

To many cardiologists, it may seem that the Ross operation converts a single-valve disease into two-valve disease. “In a sense, that’s true,” Beckerman says. “But functionally, that distinction is meaningless when the procedure shows better hemodynamics and long-term survival than mechanical or preserved tissue valve replacements.”

To refer a patient

To refer a patient, call 919-646-3915 or use Duke MedLink.

Learn more about Duke's programs by exploring our adult or pediatric websites.

Duke MedLink

The Ross procedure at Duke

With Beckerman’s arrival at Duke, the Ross operation has once again been offered to patients as part of the adult congenital heart disease program — but the Ross technique has long been offered for pediatric patients at Duke. This has led to further innovation, including using a living root in the pulmonic position, as in the infant domino partial heart transplant. “When we use a fresh, non-cryopreserved valve, we see better results,” says Beckerman. “It has the potential to further improve the Ross. Using living roots from explanted hearts shows truly good organ stewardship.”

The procedure remains an excellent option for aortic valve surgery, says Beckerman. “Any aortic valve disease is amenable to the Ross operation, whether that’s valve stenosis or insufficiency and whether there is associated aortic aneurysm or not. If your patient’s life expectancy is at least twenty years, they would benefit from a Ross performed by an experienced surgeon.”

The Ross procedure is another way that Duke offers specialized care for adult congenital heart disease whether patients are newly diagnosed or treatment is ongoing. One of only two programs in North Carolina accredited by the Adult Congenital Heart Association, Duke offers innovative treatments and therapies as one of the best hospitals in the nation for cardiology and heart surgery.

Duke Health Referring Physicians

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Autologous graft offers the best aortic valve replacement option

Misconceptions about the Ross procedure

The Ross procedure at Duke