Ross Procedure: Unique Valve Replacement Surgery for Younger Patients

The Ross Procedure

A typical aortic valve replacement surgery involves replacing the diseased aortic valve with either a mechanical or animal (porcine or bovine) valve - neither of which is ideal for children or young adults. Mechanical valves are made of very durable plastics but sentence the patient to a lifetime of blood thinning medication to prevent blood clotting, which can pose bleeding risks for a young, active person who may be more prone to cuts and bruises. Porcine and bovine tissue valves do not require blood thinners long term but only last approximately 12-15 years, which require younger patients to eventually undergo several repeat operations in their lifetimes.

On Tuesday, October 26 from 11am to 12pm, Beth Israel Medical Center in New York City will present a live Webcast of the Ross Procedure, a lesser-known surgical procedure that offers patients potential for long-term freedom from blood thinners and repeat operations, without restricting physical activity.

Cardiothoracic surgeon Paul Stelzer, MD will perform the procedure. He completed his residency training in 1981 and has been at Beth Israel since 1996. Dr. Stelzer has done over 370 of these operations and currently performs the Ross Procedure more than anyone else in the world. In fact, there are currently only approximately 50 "busy" Ross Procedure surgeons in the entire United States. Robert F. Tranbaugh, MD, chief of cardiac surgery at Beth Israel, will explain the procedure and provide background information during the Webcast.

Pioneered in 1967, the Ross Procedure involves replacing the patient's diseased aortic valve with his or her own pulmonary valve. The pulmonary valve is then replaced with a cryopreserved pulmonary valve from a human donor. The autologous (patient's own) pulmonary valve can theoretically last a lifetime since it is fully alive and normal as it replaces the aortic valve. The donor valve has proven to be the most durable of any tissue valve and lasts much longer on the low pressure right side of the heart than on the higher pressure left side. The donor pulmonary valve may provide up to 35-40 years of service without replacement since its workload is significantly less than the aortic valve. "The Ross Procedure allows patients to live a normal, active and medication-free lifestyle, making it particularly applicable for children and young adults," says Dr. Stelzer. "Patients have gone back to running marathons and even compete in triathlons after the Ross procedure."

The best candidate for the Ross procedure is someone under 45 years of age who has isolated aortic valve disease, good left ventricular function, no other valve or coronary problems and no other medical conditions which might preclude the safety of the operation.

Each year several thousand Americans under the age of 50 are found to have a stenotic (narrowed) or regurgitant (leaky) aortic valve. This condition inevitably progresses and can result in shortness of breath, chest pain, dizziness or loss of consciousness. By ignoring the symptoms, a patient runs a risk of developing advanced stages of heart failure, making aortic valve replacement surgery more risky. Appropriate evaluation by a cardiologist with regular echocardiograms can usually determine when surgery should be done before any serious heart damage occurs. This gives the patient ample time to evaluate the options for surgery to decide which operation is best suited to his or her specific condition and lifestyle.