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September 13, 2026Journal of the American College of Cardiology214 citationsOpen Access

Ross Procedure in Adults for Cardiologists and Cardiac Surgeons

AMAmine MazineIEIsmaı̈l El-HamamsySVSubodh Verma

Key Result

The Ross procedure is associated with better long-term outcomes compared with conventional aortic valve replacement in young and middle-aged adults with aortic valve disease.

Key Points

  • To review the surgical indications, technical nuances, patient selection, and clinical outcomes of the Ross procedure compared to conventional aortic valve replacement in adults.
  • Synthesized recent published reports and clinical series from specialized cardiac surgical centers evaluating the Ross procedure.
  • Reviewed patient selection criteria, procedural safety, durability, and comparative long-term survival metrics against standard prosthetic valve replacement.
  • Specialized surgical centers achieve safe and reproducible operative results with the Ross procedure in appropriately selected adult populations.
  • Growing evidence demonstrates that the living pulmonary autograft is associated with superior long-term survival and clinical outcomes compared with conventional aortic valve replacement.

PICO

P
Population
Aortic valve disease
I
Intervention / Comparator
Ross procedure (pulmonary autograft replacement) vs Conventional aortic valve replacement

Abstract

The ideal aortic valve substitute for young and middle-aged adults remains elusive. The Ross procedure (pulmonary autograft replacement) is the only operation that allows replacement of the diseased aortic valve with a living substitute. However, use of this procedure has declined significantly due to concerns over increased surgical risk and potential long-term failure of the operation. Several recent publications from expert centers have shown that in the current era, the Ross procedure can be performed safely and reproducibly in appropriately selected patients. Furthermore, an increasing body of evidence suggests that the Ross procedure is associated with better long-term outcomes compared with conventional aortic valve replacement in young and middle-aged adults. In this paper, the authors review the indications and technical considerations of the Ross procedure, describe its advantages and drawbacks, and discuss patient selection criteria. Finally, the authors provide a comprehensive synthesis of the current Ross published reports to enable cardiologists and surgeons to make appropriate decisions for their patients with aortic valve disease.

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Cite This Study

Mazine et al. (2018) conducted a review in Aortic valve disease. Ross procedure (pulmonary autograft replacement) vs. Conventional aortic valve replacement was evaluated. The Ross procedure is associated with better long-term outcomes compared with conventional aortic valve replacement in young and middle-aged adults with aortic valve disease.

synapsesocial.com/papers/6aa6161704b6164f168faa72https://doi.org/10.1016/j.jacc.2018.08.2200
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