Research Update: Are There Advantages of the Ross Procedure?

By Adam Pick on August 29, 2018

The first time I heard about the Ross Procedure I was skeptical. My first thought was, “What???!!!  You want to play musical chairs with my heart valves?  No way!!!”  Then, the more I learned about this unique procedure for patients with aortic valve disease, I started thinking, “Hmmm.  That might be the operation for me.”


Ross Procedure Diagram


In the Ross Procedure, the patient’s pulmonary valve is “switched” to the aortic position.  Then, a donor valve is placed in then the pulmonary position.

It took me awhile but I slowly started to understood the potential advantages of the Ross Procedure. First, I would get to keep my own valve. That’s great. Second, I wouldn’t need to be on blood thinners for the rest of my life. Another bonus considering I’m an active guy. Third, if I needed a future valve re-operation there is a good chance that procedure could be performed using a catheter. As we have seen together, some transcatheter valve devices are now available.

So, 12 years ago, Dr. Vaughn Starnes performed the Ross Procedure on me at USC Medical Center in Los Angeles. Since then, I have had no problems with either of my valves.



Interestingly… When I tell people about the Ross Procedure, I get a lot of confused stares and/or raised eyebrows. Some patients have no interest in a double heart valve surgery. I get that. Others are concerned by the extremely complex nature of this surgery. I get that too. Also, many people guarantee me that my valves are destined to fail.

There is no doubt that the Ross Procedure is not for everyone. But, for me, the Ross Procedure has worked out pretty darn good.


New Research Study About The Ross Procedure

Yesterday… As I scrolled through a feed about heart valve surgery, I learned new information about the Ross Procedure. So, I wanted to quickly share the research with our community.  According to a new study published in JAMA Cardiology and presented at the European Society of Cardiology Congress, the Ross Procedure provides a survival benefit when compared to mechanical aortic valve replacement in young and middle-aged patients.   Here are some key points from the research during a 5.8 year follow-up:

  • Patients receiving the Ross Procedure were 46% less like to die of any cause.
  • Patients were 74% less likely to suffer a stroke.
  • Patients were 83% less like to experience major bleeding.

The meta analysis also showed significant improvements on a quality-of-life score compared to patients receiving mechanical valves and a 58% reduction in valve- or heart-related mortality.


It’s Not All Roses for the Ross Procedure

At the same time, the study also showed that 76% of patients were more likely to require another valve surgery during follow-up.  That data point definitely caught my eye as a potential red flag for patients considering the Ross Procedure.

Commenting on this, Sir Magdi Yacoub, a leading heart surgeon in Europe, noted, “The causes of reoperation are largely preventable and, when they occur, can be treated by modern percutaneous approaches or low-risk reoperation in a center with experienced practitioners.”


Sir Magdi Yacoub


Once again, I think this story elevates a common theme for patients needing a heart valve replacement procedure.  That theme is that there is no “perfect valve”.  There are pros and cons to just about every type of heart valve replacement.  That said, I encourage all patients to do their homework and select the right valve, the right procedure, and the right medical team for you!!!

Keep on tickin!

Written by Adam Pick
- Patient & Website Founder

Adam Pick, Heart Valve Patient Advocate

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

Dayna Wiggins Oldenburg says on August 30th, 2018 at 1:05 pm

My son had the Ross Procedure at 4 years old and had his next open heart to replace the donated pulmonary valve at 14 years old. His “musical chair” valve in the Aortic position is still doing really well. We are so thankful for our amazing pediatric surgeon who performed both surgeries. Also so thankful that he never had to be on major blood thinners especailly being so young. Currently with the new porcine valve he takes only a baby aspirin and has a clear for all sports.

Adam says on August 30th, 2018 at 1:14 pm

Karen Grein says on August 30th, 2018 at 1:19 pm

Our 12 yr old son, Dan, just had the Ross Procedure done in June at Lurie’s Children’s Hospital in Chicago. Dr. Guy Randolph, his Cardiologist since he was a baby, researched and suggested the Ross Procedure as his best option. Dr. Carl Backer did his surgery. Dr. Backer also wrapped Dan’s aortic stem with a polymer so the new valve wouldn’t leak / dialate as much. It went very well. For the first time in his life, restrictions have been lifted and he is going out for the basketball team this fall. He leakage went from almost severe to trivial. Good luck to all and stay positive!

Dean Menta says on August 30th, 2018 at 1:19 pm

I had a Ross Procedure in 1999 performed also by Dr, Vaughn Starnes at USC Med Center and it failed after 6 months. One of the leaflets in the new aortic position had torn. I had to have another surgery and wound up with a St. Judes mechanical valve. I had no issues with the mechanical valve for several years until 2014 when I was diagnosed with a aortic aneurysm. Dr. Starnes again performed surgery to repair that and also, at my request, replaced the mechanical aortic valve with a tissue valve. I did so to get off of Coumadin. Since that last surgery I have been doing great with zero complications or issues of any kind. Whew!

Jessica Urton says on August 30th, 2018 at 1:20 pm

I had the Ross Procedure 2 Years ago this Sunday! Since then, I have had my pulmonary valve replaced via catheter last September and I am currently going through the process of having that valve replaced again. Third times the charm right?

Adam says on August 30th, 2018 at 1:22 pm

Karen, I loved reading this. Congratulations! Give my best to your son! Here’s to a great basketball season!

Adam says on August 30th, 2018 at 1:25 pm

Hi Dean, Great to meet you! I guess we’re surgical brothers considering Dr. Starnes took care of both of us. Sorry to hear you’ve had a few bumps in the road. I’m also so happy to hear you are now doing great with zero complications after your last procedure.

Dean Menta says on August 30th, 2018 at 1:27 pm

My Brother!! Ha! Glad to know you are doing well, too. Keep up the great work! 🙂

Adam says on August 30th, 2018 at 1:33 pm

You said it… The third time is the charm. My thoughts are with you Jessica!

Damian says on August 30th, 2018 at 1:44 pm

Jessica, I’m sorry to hear that and sympathize. I’m 3.5 years post-Ross with Dr. Stelzer and due to localized scarring near the pulmonary valve pressuring the valve I developed severe pulmonary stenosis and now need to decide on what type of procedure to repair the pulm valve. I’m considering both OHS and TVPR. I think we could help each other if you aren’t too far along. I was able to find a list of surgeons that perform the TPVR and found a few that have performed over 100, which is hard to find. They are mostly in California. Doff McElhinney from Stanford has performed over 200 TPVR procedures. Do you have any recommendations? I’m east coast based. For the broader community: If the pulm valve lasted 15 years I would have been satisfied choosing Ross with infrequent pulm valve management, but now I have to manage 2 valve issues and the pulmonary valve will be a recurring issue not a quick fix. Upon reflection, I’m not sure if I would have chosen Ross given the likelihood of multiple lifetime surgeries. I also don’t think the downside of Ross has been sufficiently explored. For example, research showing % of re-op within 5 and 10 years & what re-op options are available. I’m certainly doing my research now. Its a tough decision to be sure.

Grant says on August 30th, 2018 at 1:49 pm

Is there any way to get an update on the Ross Procedure from Dr. Paul Stelzer with the recent findings? Maybe an updated video conference with the expert?

Damian says on August 30th, 2018 at 1:53 pm

Adam, I have conducted a fair amount of research on TPVR. If you want, I can share my research. Further to my note to Jessica,I would recommend highlighting the % chance for re-op for Ross on either valve and the implications for such re-op. For example, TPVR may require medium term anti-coagulants and lifetime aspirin as well as risk of endocarditis. These aspects should also be considered when deciding Ross i.e. what are my future pulmonary and aorta operations. I’m certainly guilty of not thinking about next steps when deciding Ross, which I think was partly due to overwhelm of my first procedure and wishful thinking hoping I would be the lucky one and both valves would last a very long time…

Adam says on August 30th, 2018 at 5:07 pm

Hi Damian, Thanks! Quick thought… Would you like to post together a “Guest Post” to help educate our community? I could then syndicate it across our global platform. Thoughts?

Debby Berger says on August 30th, 2018 at 7:01 pm

I am 6 mo’s post Ross procedure and despite some initial quite painful sternal issues but now more tolerable pain along the incision, I am lucky to return to a very active lifestyle. I am pacing myself at this time of course. I am curious what symptoms were had with pulmonary valve malfunction. Was SOB the indicator?
I wish everyone the very best.

Kristina Hebert says on August 31st, 2018 at 8:44 am

I had the Ross Procedure performed in June of 1996 at the age of 27, now 22 years later the procedure is still working well for me. I’m so thankful that my cardiologist in my rural Louisiana hometown area recommended that I travel to Tennessee for Dr. Michael Patracek to perform the procedure. After my surgery I was so amazed at the simple things I was able to do with my two children. In my mind, I can still see their little faces when I said I was ready to ride the bikes with them. I will forever be thankful for being given a new lease on life!

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