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Ross Procedure: Failure Rates, Reinterventions and Life Expectancy

Written By: Allison DeMajistre, BSN, RN, CCRN
Medical Expert: William Brinkman, MD, Director, Thoracic Aortic Clinic, Baylor, Scott & White, The Heart Hospital-Plano, Plano, Texas
Reviewed By: Adam Pick, Patient Advocate, Author & Website Founder
Published: October 27, 2026

The Ross Procedure is a highly complex, multifaceted aortic valve replacement surgery that requires an experienced surgeon working in a high-volume, specialized center to ensure a successful outcome. The Ross Procedure differs from other aortic valve replacement operations in that it requires intervention on both the aortic and pulmonary valves. Specifically, the surgeon removes the patient’s pulmonary valve and re-implants it into the aortic valve position. The re-implanted pulmonary valve is called an autograft. A healthy donor valve, or homograft, is then placed into the pulmonary valve position. Although the Ross Procedure is complicated and has associated operative risks, it has emerged as a viable long-term solution for younger patients with severe aortic valve disease.

We recently received a patient question from Scott about the Ross Procedure, who wanted more information about the possible problems and solutions associated with it. Scott asked, “My question would be about failure rates in the Ross Procedure. Which is more likely to fail, the homograft or the autograft, and when? Also, how are those reinterventions performed?” Adam Pick, founder of HeartValveSurgery.com and a 20-year Ross Procedure recipient, met with Dr. Bill Brinkman, Director of the Thoracic Aortic Clinic at Baylor Scott & White The Heart Hospital-Plano in Plano, Texas. Dr. Brinkman has performed over 3,500 cardiac surgeries and is an expert in the Ross Procedure.

Facts About Ross Procedure Failure Rates, Reinterventions, and Life Expectancy

Here are the key insights shared by Dr. Brinkman:

The outlook for Ross Procedure patients. In response to Scott’s question regarding failure of the homograft or autograft, Dr. Brinkman said, “Well, the good news is that neither of them is very likely to fail. When I look at data from our center and others that have long-term outcomes, I usually tell patients about 10 percent per decade.” He explained that the failure rate for both the autograft and homograft is about the same. “It also depends on how the autograft is implanted and how it is supported. My personal bias is that the way we’re doing it now is better than how it was done 10 to 15 years ago, but it takes 10 to 15 years to prove that. I think it’s only going to get better.” Dr. Brinkman went further and explained that, in his estimation, there is only a 30 percent chance that a patient who had a Ross Procedure at 50 years old would need a reintervention at 80.
If a valve fails, reintervention depends on several factors. Dr. Brinkman said, “A Ross Procedure reintervention can be treated with a transcatheter approach in both the autograft and pulmonary positions. It depends on how the valve was implanted. Generally, if the patient is older than 65 or 70, the goal would be to use a transcatheter approach. If it’s a younger patient who had a Ross Procedure at 14 and needs a revision at 41, it would be done with open surgery by a surgeon who’s experienced with the Ross.”
How does reintervention affect life expectancy? “When we look at the data on Ross reinterventions at our center, there was no effect on life expectancy. Patients stayed on the same normal survival curve, especially if the autograft is preserved. If the reoperation is for dilation of autograft tissue and the valve leaflets are still intact, it’s a really good situation.”

Thanks, Dr. Brinkman and Baylor, Scott & White!

On behalf of all the patients in our community, thank you, Dr. Bill Brinkman, for everything you and your team are doing at Baylor, Scott & White The Heart Hospital- Plano in Plano, Texas.

Written by Adam Pick - Patient & Website Founder

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com 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.

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Video Transcript:

Adam Pick: Hi everybody, it's Adam with HeartValveSurgery.com, and we're at the American Association for Thoracic Surgery meeting in Chicago, Illinois. I'm thrilled to be joined by Dr. Bill Brinkman, who is the director of the Thoracic Aortic Clinic at Baylor Scott & White, the Heart Hospital, Plano. Dr. Brinkman, it is great to see you again, and thanks for being with me today.

Dr. William Brinkman: Great to see you. We're here at AATS, and we have questions coming at us here at AATS from patients all over the world, and this question comes in specifically for you, given your specialty in the Ross procedure. The question is from Scott, and he asks, "My question would be about failure rates in the Ross. Which is more likely to fail, the homograft or the autograft, and when?" And the follow-up question is, "How are those reinterventions performed?"

Dr. William Brinkman: Well, the good news is neither of them are very likely to fail.

When I look at data from our center and other centers that have very long-term outcomes, I usually tell patients it's about 10% per decade. And really, whether it's the autograft that fails or the homograft that fails, um, it's, it's about the same it also depends on how the autograft is implanted and how it's supported.

My personal bias is that the way we're doing it now is better than it was, how it was done 10, 15 years ago, but it takes 10 to 15 years to prove that. So I think it's only going to get better. So I'd say, you know, a, a 50-year-old who gets a Ross, um, I'd say there's about... if he lives till 80, there's about a 70% chance that he wouldn't need an intervention.

Adam Pick: Wow.

Dr. William Brinkman:: So that's pretty good.

Adam Pick: If though by some chance there is a failure, is that treated surgically or using a transcatheter approach?

Dr. William Brinkman: It depends. Now, a Ross can be treated with a transcatheter approach in the, in the autograft position and the pulmonary position. It depends on how it was implanted. But generally, if we can get you, my goal would be to get a patient, you know, greater than 65 or 70, and then they would, if their valve failed, we could do a transcatheter approach.

Now, if it's a younger patient who maybe had a Ross at age 14 and now he's 41, needs a revision, that would be open surgery, and it would need to be done by a surgeon who's experienced with the Ross.

Adam Pick: Final question is, if there is a re-intervention, how does that impact the patient's life expectancy?

Dr. William Brinkman:: We looked at our data on reinterventions on Ross at our center, and actually, it didn't impact it. They stayed on the same normal survival curve, especially if we can preserve the autograft.

Many times we can. If the reason they're getting reoperated on is for dilatation of the autograft tissues, but the valve is, leaflets are still intact, that's, that's a really good situation.

Adam Pick: That's fascinating to learn. And Dr. Brinkman, on behalf of the patients in our community, people all over the world, thanks to you and your team at Baylor Scott & White, the Heart Hospital, Plano.

Thanks for everything you're doing.

Dr. William Brinkman: Thank you.

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