Ross procedure or living pulmonary autograft is an alternative for young and middle aged individuals requiring aortic valve replacement in view of the faster degeneration of bioprostheses in this age group and the thromboembolic and bleeding risks with mechanical prosthesis. Charitos EI et al from Luebeck in Germany report a large series [Long-Term Results of 203 Young and Middle-Aged Patients With More Than 10 Years of Follow-Up After the Original Subcoronary Ross Operation. Ann Thorac Surg. 2012;93:495-502] of over two hundred cases with more than a decade of follow up, from among nearly six hundred Ross procedures performed in their center between 1994 and 2011. The data is exclusively on the original subcoronary Ross operation and the follow is of about two thousand and five hundred patient years. Ninety two percent had freedom from re-operation at ten years and eighty seven had freedom from re-operation at fifteen years. Early mortality was less than one percent and late mortality was about eleven percent. No significant increase in aortic regurgitation or root dimension was noted on follow up.
The original Ross procedure described in 1965 [Ross DN. Replacement of the aortic and mitral valves with a pulmonary autograft. Lancet. 1967; 2: 956–958] was a subcoronary implant. Full root replacement is the most common operation with the Ross principle being performed now [Sievers HH et al. A Critical Reappraisal of the Ross Operation – Renaissance of the Subcoronary Implantation Technique? Circulation. 2006; 114: I-504-I-511]. Advantages of Ross procedure are the good hemodynamic characteristics, low thrombogenicity and hence doing away with anticoagulants and the potential for growth as the child grows up. But the concerns are the complexity of the procedure (including the need for replacing both aortic and pulmonary valves) and till date the non availability of data on long term performance of the pulmonary valve at the aortic position. The 2006 paper in Circulation cited above gave the mid term results from the same center and the senior author of the paper was Donald N. Ross.