Ross procedure

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Ross procedure
Intervention
ICD-9-CM	35.21

The Ross procedure (or pulmonary autograft) is a cardiac surgery operation where a diseased aortic valve is replaced with the person's own pulmonary valve. A pulmonary allograft (valve taken from a cadaver) is then used to replace the patient's own pulmonary valve. Pulmonary autograft replacement of the aortic valve is the operation of choice in infants and children, but its use in adults remains controversial.^[1]

History

The Ross procedure is named after Mr. Donald Ross - a pioneer in cardiac surgery in the UK - who proposed the procedure in 1962^[2] and first performed it in 1967.

Advantages / Disadvantages

Advantages

Freedom from thromboembolism without the need for anticoagulation.
The valve grows as the patient grows (i.e. children).
Favourable hemodynamics.
No foreign material present in the valve.

Disadvantages

Single valve disease (aortic) treated with a two valve procedure (aortic and pulmonary).

Pulmonary valve replacement

One of the main objections to the Ross procedure is the genesis of pulmonary valve disease in addition to aortic valve disease. Proponents have argued that biological valves implanted in the pulmonary position would be slow to develop dysfunction, and any dysfunction would be well tolerated due to the lower pressures in the right side of the heart. Survival of homografts in the pulmonary position is good (20-year freedom from reoperation of 80%), and homograft dysfunction is infrequently implicated in the observed morbidity and mortality.^[3]

Homografts (aortic or pulmonary) should be the replacement of choice; no other valve performed as well in the pulmonary position. Many homograft valves are sterilized with ethylene oxide or irradiation -- methods recognized to have deleterious effects on valve performance. The results of the pulmonary autograft procedure are likely to be superior with the use of fresh homograft valves.^[3] Today, cryopreservation is the method of choice for homograft preservation.

References

↑ Yacoub M, Klieverik L, Melina G, Edwards S, Sarathchandra P, Bogers A, Squarcia U, Sani G, van Herwerden L, Takkenberg J (2006). "An evaluation of the Ross operation in adults". J Heart Valve Dis 15 (4): 531–9. PMID 16901050.
↑ Ross D (1962). "Homograft replacement of the aortic valve". Lancet 2 (7254): 487. doi:10.1016/S0140-6736(62)90345-8. PMID 14494158.
↑ 3.0 3.1 Chambers J, Somerville J, Stone S, Ross D (1997). "Pulmonary autograft procedure for aortic valve disease: long-term results of the pioneer series". Circulation 96 (7): 2206–14. PMID 9337191.

External links

Healthcare science – Medicine / Surgery / Cardiac procedures (ICD-9-CM V3 35–37+89.4+99.6, ICD-10-PCS 02)

Surgery and IC

Heart valves and septa	Valve repair Valvulotomy Mitral valve repair Valvuloplasty aortic mitral Valve replacement Aortic valve replacement Ross procedure Percutaneous aortic valve replacement Mitral valve replacement production of septal defect in heart enlargement of existing septal defect Atrial septostomy Balloon septostomy creation of septal defect in heart Blalock–Hanlon procedure shunt from heart chamber to blood vessel atrium to pulmonary artery Fontan procedure left ventricle to aorta Rastelli procedure right ventricle to pulmonary artery Sano shunt compound procedures for transposition of great vessels Jatene procedure Mustard procedure for univentricular defect Norwood procedure Kawashima procedure shunt from blood vessel to blood vessel systemic circulation to pulmonary artery shunt Blalock–Taussig shunt SVC to the right PA Glenn procedure

Cardiac vessels	CHD Angioplasty Bypass/Coronary artery bypass MIDCAB Off-pump CAB TECAB Coronary stent Bare-metal stent Drug-eluting stent Bentall procedure Valve-sparing aortic root replacement

Other	Pericardium Pericardiocentesis Pericardial window Pericardiectomy Myocardium Cardiomyoplasty Dor procedure Septal myectomy Ventricular reduction Alcohol septal ablation Conduction system Maze procedure Cox maze and minimaze Catheter ablation Cryoablation Radiofrequency ablation Pacemaker insertion Left atrial appendage occlusion Cardiotomy Heart transplantation

Diagnostic
tests and
procedures

Electrophysiology

Electrocardiography

Vectorcardiography

Holter monitor

Implantable loop recorder

Cardiac stress test

Bruce protocol

Electrophysiology study

Cardiac imaging

Angiocardiography

Echocardiography

TTE

TEE

Myocardial perfusion imaging

Cardiovascular MRI

Ventriculography

Radionuclide ventriculography

Cardiac catheterization/Coronary catheterization

Cardiac CT

Cardiac PET

sound: Phonocardiogram

Function tests

Pacing

M: HRT

anat/phys/devp

noco/cong/tumr, sysi/epon, injr

proc, drug (C1A/1B/1C/1D), blte

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