The Ross Procedure in Infective Endocarditis: An Underestimated Surgical Treatment in Somatic Growth

The Ross procedure is a cardiac surgical intervention in which the aortic valve is replaced with a pulmonary autograft. Aortic valve replacement is the most common surgical procedure worldwide for cases of infectious endocarditis. The treatment approach for patients typically involves conventional mechanical prostheses or stent-supported bioprostheses. Conversely, aortic homograft and pulmonary autograft are often employed in more restricted applications. In cases where the aortic infection has spread, affecting the aortic root or the aortic–mitral continuity and prosthetis valve endocarditis, it is recommended to use an aortic homograft. The use of a pulmonary autograft is not recommended in such cases. Prosthetic stentless bio-roots or prosthetic valved conduits with mechanical or biological valves are considered viable alternatives because the Ross procedure is considered a more intricate surgical intervention, entailing the implantation of two valves. This treatment option has been utilized successfully to address cases of infective endocarditis in adult and pediatric patients alike. However, its application is restricted to a limited number of patients enrolled in registries maintained by high-volume centers or centers with substantial expertise in the Ross procedure, where the complexity of the surgical intervention is adeptly managed. In this review, we aim to discuss the role of the Ross procedure in treating cases of infective endocarditis in adults and children. We will cover the procedure’s relevant indications and contraindications, as well as the risks and benefits associated with its use. Finally, we will analyze the results of the Ross procedure and compare them to those of other treatment options.