The Ross operation (also called the pulmonary autograft procedure) is a surgical technique for replacing a diseased aortic valve using the patient’s own healthy pulmonary valve. The pulmonary valve, which is moved into the aortic position, is then replaced with a donated human valve (homograft) or a biological substitute in the pulmonary position. The procedure was first described by Donald Ross in 1967.
The Ross operation is primarily used in younger adults and children with severe aortic valve disease, where the alternatives (mechanical valves requiring lifelong anticoagulation, or biological tissue valves that degenerate within 10 to 20 years) have significant limitations. Because the autograft is living tissue from the patient’s own body, it integrates into the aortic position, does not trigger an immune rejection response, and can grow with the patient. This makes it particularly suitable for children and young adults in whom valve growth over decades is important.
The main advantages of the Ross operation are that the aortic autograft has excellent long-term durability (the pulmonary valve in the aortic position has functioned well for 20 to 30 years in many recipients), it does not require lifelong anticoagulation with warfarin (unlike mechanical valves), and it provides excellent haemodynamic performance. The principal drawbacks are surgical complexity (it is a more demanding operation than standard valve replacement), the conversion of a single-valve problem into a two-valve problem (both positions require intervention), and the risk of autograft dilation and failure over time.
In the context of cardiac arrest, the Ross operation is relevant where severe aortic valve stenosis or regurgitation contributed to the cardiac event. Post-Ross patients typically do not require an ICD on the basis of the procedure alone unless other risk factors are present, but require regular echocardiographic surveillance of both the autograft and the homograft positions, and follow-up at a specialist adult congenital and valve disease centre.
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