Ross and Aortic Valve Preserving Surgery Program
Ross and Aortic Valve Preserving Surgery Program
The Ross and Aortic Valve Preserving Surgery Program focuses on providing durable solutions for younger patients with aortic valve disorders. It offers three related, highly specialized procedures, namely the Ross procedure, aortic valve repair and aortic valve-sparing root replacement, that offer superior results in younger patients with aortic valve disease.
In younger patients with long life expectancy, especially those under 60 years of age, traditional aortic valve replacement (AVR) does not perform as well as in older patients. In older patients, traditional AVR restores normal life expectancy. However, in younger patients, traditional AVR with either bioprosthetic or mechanical valves leads to reduced life expectancy. The Ross procedure is the only aortic valve replacement procedure that has reliably been shown to restore normal life expectancy in younger patients. There is emerging data that aortic valve repair and aortic valve-sparing root replacement also restore normal life expectancy.
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Ross Procedure
When a young patient has aortic valve disease that cannot be repaired, typically aortic stenosis or some forms of aortic insufficiency, we offer the Ross procedure. During the Ross procedure, we replace the diseased aortic valve with the patient’s own pulmonary valve. The pulmonary valve is then replaced with a cadaveric valve.
When placed in the aortic position, the pulmonary valve continues to live. The pulmonary and aortic valves have very similar structure, and after the Ross procedure, the pulmonary valve takes on the form of a native aortic valve and becomes nearly indistinguishable from one. Because it remains alive, it has excellent durability, does not require blood thinners and has low rates of infection.
Aortic Valve Repair
Aortic valve disease can broadly be divided into aortic stenosis, where the valve is too tight and doesn’t allow blood to be easily pumped out of the heart, and aortic insufficiency, where the valve is “leaky” and allows ejected blood to leak back into the heart. Both conditions, if untreated, can lead to heart failure.
Valves with aortic stenosis cannot be repaired. Patients with aortic stenosis are treated with the Ross procedure if they are younger, or traditional aortic valve replacement if they are older. On the other hand, many aortic valves with insufficiency (or leaking) can be repaired. Aortic valve repair offers many of the same advantages of the Ross procedure, as patients keep their own living aortic valve.
Aortic Valve-Sparing Root Replacement
The aortic valve sits at the border of the heart and the aorta. The heart squeezes blood into the aorta - the body’s largest blood vessel. Normally, the aortic valve opens to allow the blood to be ejected into the aorta with little resistance, and then closes to prevent this ejected blood from going backwards into the heart.
The very first part of the aorta that houses the aortic valve is called the aortic root. When the aortic root enlarges, it is called an aortic root aneurysm. Aortic aneurysms can lead to two life-threatening problems - aortic dissection and rupture. Large aortic aneurysms are treated with prophylactic surgery to prevent these catastrophic complications.
Because the aortic valve sits within the aortic root, the majority of aortic root replacements in the United States also replace the aortic valve, even when the valve is normal. However, in these patients we offer aortic valve-sparing root replacement, whereby we replace the aneurysmal aortic root and preserve the patient’s own, living aortic valve.
Marko Boskovski, MD, MHS, MPH
Assistant Professor of Surgery
Division of Cardiothoracic Surgery
Director of Ross and Aortic Valve Preserving Surgery
Elaine Tseng, MD, FACS, FAHA
Professor of Surgery
Division of Cardiothoracic Surgery
Chief of Cardiac Surgery, San Francisco VA Healthcare System
Co-Director, Cardiac Biomechanics Lab
