The Ross Procedure: Am I Too Old?

The Ross Procedure is a highly advanced surgical procedure that replaces a patient’s diseased aortic valve with their own pulmonary valve. A donor valve is then implanted in the pulmonary position. It’s a formidable solution for many patients with aortic valve disease because it doesn’t require lifelong anticoagulation and doesn’t involve a bioprosthetic valve that may require another replacement ten to fifteen years down the road. Although it is a technically difficult operation, recent data on the Ross Procedure for patient survivability and valve longevity remain favorable, leading many patients to seek more information to determine whether it might be the right surgery for them.

We received an interesting patient question about Ross Procedure candidacy from Lisa, who asked, “I’m a healthy 56-year-old woman. I was diagnosed with moderate bicuspid aortic valve stenosis and a 4.6 ascending aortic aneurysm. How old is too old to have a Ross Procedure, and would it be appropriate for a bicuspid aortic valve and aneurysm patient?” To answer Lisa’s question, Adam Pick, former Ross Procedure patient and founder of HeartValveSurgery.com, met with Dr. Juan Pablo Umana, the Chief of Cardiac Surgery at the University of Miami Health System in Miami, Florida.

Video available online at:

https://www.youtube.com/watch?v=clf4LHrMX98

Facts About Age and Ross Procedure Candidacy

Here are the key insights shared by Dr. Umana:

• First, a quick answer for Lisa. “That is a very good question, Lisa, and I think the short answer is you are a candidate for a Ross Procedure,” said Dr. Umana. “Patients with bicuspid aortic valves and aortic stenosis are wonderful candidates for a Ross Procedure. To fix the ascending aortic aneurysm, we can replace it after replacing the aortic valve with the pulmonic valve.”

• Age can be a limiting factor. “Now, regarding age, there are some limitations. What we are seeing is that after 60, it may not be a good idea to do a Ross Procedure because, as we get older, we lose collagen. Our tissues become more rigid, and the same thing happens to the pulmonic valve,” said Dr. Umana. “As a consequence, it lasts less than it should. As a result, my cutoff is 60 years of age.  I think patients who are healthy at 55 or 56 should undergo a Ross Procedure, given good heart function and the fact that today’s life expectancy for a 56-year-old is probably 80 years.”

• The Ross Procedure is a good solution for younger patients. “We must be able to offer an operation that restores life expectancy in that age group, where we are in a gray zone between a mechanical valve and a bio prosthesis. I think the Ross Procedure fits perfectly in there and should be a one-and-done in terms of a valve replacement for aortic stenosis.”

Thanks Dr. Umana and the University of Miami Health System!

On behalf of all the patients in our community, thank you, Dr. Juan Pablo Umana, for everything you and your team are doing at the University of Miami Health System in Miami, Florida!

Related links:

• See Dr. Juan Pablo Umana's Interactive Surgeon Profile

• Explore the Ross Procedure Patient Education Center

• Bicuspid Aortic Valve - What Should Patients Know?

Keep on tickin,
Adam

P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. Umana below.